Immediate Fixed Implant Supported Hybrid Prosthesis (all-on-4 technique) from start to finish, a complete case

Part 6 - Impressions and Removal of Temporaries

Instructors:

Mark Margolin, DDS

Mark Margolin, DDS

Currently in full time private practice at the Berland Bental Arts Center, which is a group practice providing comprehensive dental care in one location.  He provides the surgical and sedation aspect of the practice.

Lorin Berland, DDS

Lorin Berland, DDS

Dr. Berland is a Fellow of the American Academy of Cosmetic Dentistry (AACD), the co-creator of the Lorin Library Smile Style Guide, and the developer of the Web site , www.denturewearerscom.

Dr. Margolin discusses with the laboratory technician on whether to do a direct or indirect impression

One thing which I noticed when we're doing cases and every patient of course is an individual. You might handle each case a little bit differently is sometimes we'll do a direct impression technique and sometimes we'll do an indirect impression technique. Do you want to walk us through a little bit about why you want one versus the other. That's correct. I would rather go with the direct technique on the maxilla just for the simple fact that you have stop in the palate. You can kind of orientate the denture. You have a visual on the incisal edge position and the smile line. So these two factors help you position the denture. On the lower I would go with an indirect technique because basically I think it's the most daunting phase for the restorative dentist. You took the bone away. You have four post and you're trying to orientate the denture and make it function according to their diagnostic workup you made working the space. So instead of doing that I would rather fix the lower denture onto the maxilla. The orthodontic cast were already previously made. And this way it's fixed. And then you place impression post on the implants and basically take an impression using the lower denture as a tray. And so this way it allow you to guide the patient into centric, control your vertical and you capture all of that into your lower denture basically. And then you take it out and place analogs and pour out the cast and basically convert the denture on the cast outside of the patient's mouth. I think it's very predictable and it's less of a mess. Open please as wide as you can. Now we have the retention pins out from our final impression. Here we go and the beautiful impression by Dr. Berland. Looks like we got everything. And at this point we are ready to let Greg repair and add our two other multiunit abutments to his provisional prosthesis. At this point, we'll probably be wrapping up to this visit. What we have left to do now, next visit we'll be basically the same visit. But the other arch we will do our final CAD/CAM bar try in. And he'll be ready for the insertion of the final prosthesis on his mandible. And then there will be one more visit after that to insert his final maxillary prosthesis and his restorations at that point will be complete. I am so excited about today. This has been a long process and very happy it's almost over. As you can see I have my temps in. My teeth in the past before we started this were quite a mess and has huge gaps between my two front teeth and my teeth were starting to spread and they were just in very bad shape. Thanks to Dr. Berland and his team they have really done an incredible job especially with my dental phobia. They've done a great job in making me be very comfortable. I had no anxiety about it which is amazing especially if you ask my wife. And I'm very excited because today is the day I finally got my temporaries taken out and the permanent put in. You'll notice there's still a little gap in my front teeth and that's because I had a huge gap in my regular teeth before I started this procedure. And I told Dr. Berland that I was concerned that when people would first see me when I came back it would be every noticeable if I went from a huge gap to no gap at all. So we left a little of a gap and now after several months of wearing this little gap now we're going to close it completely and I'm sure most people won't even notice but I'll notice and I'm very excited about it to finally have what I'll consider a Hollywood smile. I've been waiting a long time for this. And I'm just so excited and so happy to be here to get the final procedure done and I just can't wait to see the final outcome within the next couple of hours.