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

Part 4 - Impressions

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.

Reline of the denture

I am getting ready to reline the denture, take out the implants and proceed with the fixed bridge. Open please, Michael. Thank you. I want to see if it's fitting. I think there's a little impingement here but it doesn't seem to be the implant. I think it might be the tuberosity back here. Okay. I'm going to step out. I'm going to adjust this. It might be a little bit of the implant. We want a passive seat so if anything I might remove too much. Okay. We just relieved the denture. Open a little bit. Again we're looking for the passive seat. That drops in. Bite down please. Okay. Let's just check this with the bite. We have a prefabricated bite registration from the laboratory. And this will ascertain that we've got the right vertical dimension. Open please. And the right rotation and translation. Right position in the 3D, three dimensional position. Go ahead and bite down. And as you can see we have the bite right here. Everything is locked in. Okay. Open please. Open one more time. Perfect. Can you rinse up his tongue and everything. Okay. We're going to put some retentive grooves here now and then we'll pick up the implants in the Blu-Mousse. Okay. We ascertain the passive fit of the denture. And now we put in the retentive groove so that we can apply the Blu-Mousse and pick up the implants. You might notice that Michael had a big diastema. It was it was accentuated by the loss of the back teeth that cause the front teeth to splay and spread even more. Now we don't want to create such a huge difference so we closed the diastema but left it slightly open. If when we did the final prosthesis Michael decides he wants the space closed completely and we'll determine that with composite mockup then we'll do that. And the nice thing is when he's all done and people say, ìJeez, you look so great.î He doesn't have to say well I have the All on 4 procedure. He could say, well I did some orthodontics and bleaching. So open please. Okay. I just want to check one more time. Everything is looking really good. Okay. Away we go. We're going to dry this up. I'm going to need some great teamwork here with my super assistant, Donita. I'm going to reconnect with predetermined bite registration. This is a very crucial step. We go the bite on the upper teeth and now we're going to use the 60-second Blu-Mousse to grab an impression and pick the implants. I like 60 seconds. They make a 30 seconds bite registration but I'm not here to win any races. What's 30 seconds? Open really wide Michael. I'm going to really need your help here. I'm going to put some glop into the denture. Lay it on the implants. And then I'm going to have your bite down like you normally do. Hold that pose. Thank you. And now gently bite down and close. And we'll just hold that for one minute. We'll set the timer. As you can see we've got a nice bite, nice lock and we know we got the right anterior and posterior position and the correct bite as predetermined before we made the teeth. There we go. Okay. Open please. I'm going to take this out. Open a little bit more Michael. Thank you very much. Open please. Open a little more. There we go. Let's take a look. All right. It looks good. We've got all good impression of all the implants and now we're going to take in the laboratory and alleviate it and make enough room and we'll take out the location of the implants next. And I just want to verify the vertical dimension. We're just about there. If anything we might be a millimeter or so longer which is just fine because his vertical dimension with the pre-op was reduced because his front teeth had splayed forward. Okay. Open please. This is really a fantastic service to provide for patients. It's not just giving a patient teeth. This is something which is really life changing for patients. When we have patients who come in who have a hopeless dentition it's not just their teeth that is affected. I mean these are people who come in, they're often depressed. It really affects not just your teeth. It affects your self esteem. And if you're able to provides somebody with a solid set of teeth for function, a beautiful smile. I mean you are affecting their whole life. You're giving them their self esteem back. We see changes in our patients from start to finish. It's like there are new person when they're done. We've seen patients, look at the patients in our video Michael. Throughout this video if you just look at him you'll see the changes in him. He started exercising again. He lost a lot of weight. He started shaving. He looks like a new man at the end and he feels like a new man in the end. It gives the patient inspiration to recapture the person the person that they used to be before they ran into this dental problem. So it really is a fantastic technique to be able to offer to your patients. Its' real something you can do to not just fix your mouth but really to change their lives.