1. Immediate Provisionalization
and Restoration of the Fully
Edentulous Arch Using
Zimmer® RevitaliZe™ Patient
Solutions
Presented by Dr Robert Cain and
Debra Hall-Fisher, RDH
Sponsored by Dr Robert Cain
And Zimmer Dental, Inc.
2. Conventional Implant Therapy
• For Dentate Patients
– Fabricate immediate denture
– Extract remaining teeth, bone graft, seat denture
– Heal for 3 – 4 months
– Place implants, cover with tissue, wear denture
– Heal 4 – 6 months
– Uncover, place healing abutments
– Fabricate final prosthesis
3. Conventional Implant Therapy
• For Edentulous Patients
– Possibly augment bone prior to implant
placement
– Place implants, cover with tissue, continue to
wear denture
– Heal 4 – 6 months
– Uncover, place healing abutments
– Fabricate final prosthesis
4. Treatment Rationale
Why?
Patients that are fully edentulous may benefit from
Immediate Loading of a prosthesis
often it can eliminate the need for a second surgery
Usually reduces the number of post-op visits for
Prosthetic maintenance
Increases the patient’s overall comfort
Provides immediate restoration of dental function
Offers immediately improved aesthetics
5. Treatment Rationale
• When?
When a patient has mostly hopeless teeth – it
can sometimes be more costly in the long
term to try to repair and maintain severely
deteriorated dentition than to replace a full
arch with implants and an implant-retained
denture.
6. Treatment Rationale
• When?
A patient has adequate bone - minimum of 10 mm
used to be considered mandatory – but not absolutely
necessary with tilting implants
A patient has adequate bone width – at least 6 mm
wide to accommodate a small diameter implant – but
today osteotome techniques and bone grafting makes
more options possible
You want to offer a solution that can be a complete
“game – changer” for a patient
7. Pre-Treatment Diagnostics
• Overall health Screening- resulting in good
health rating
• Diagnostic radiographs
• Vertical dimension records
• Articulated casts
• Measurement of Gingival thickness
• Verified Wax try-in
8. Pre-op phase
• Patient Sharon
• Med Hx: throat
cancer with
radiation, severe
xerostomia, rampan
t caries
• Previous
mandibular
extractions, 2
implant Locator
overdenture
17. Surgical phase• Placing the Angled Tapered Abutments:
• Floss threader is placed through the floss hole and the abutment is delivered to the mouth, aligning
the cone to the abutment to parallel the anterior sites. The abutment delivery tool is used to assist
in placing and aligning the abutment.
• The 1.25mm Hex Driver is used to tighten the abutment retaining screw which is preassembled in
the abutment.
• The 30° Angled Tapered Abutment is used in the posterior implant sites.
18. Surgical phase
• Angled Tapered Abutments with Abutment Delivery
Tools:
• The abutment delivery tools can be used to aid in the
visualization of the alignment and position of the
abutments.
19. Surgical phase
• Torquing the Abutment Retaining Screws:
• The Restorative Torque Wrench is used to torque the Angled Tapered
Abutment retaining screws.
• The abutment retaining screws are torqued to 30Ncm.
• The Abutment Delivery Tools are removed by unscrewing
counterclockwise.
22. Surgical phase
• Ready for Provisionalization:
• The patient can be transferred from the surgical
operatory to the restorative office for the
provisionalization of the patient’s denture.
26. Restorative phase
• Reseat the denture and check the patient’s
occlusion – making sure there is sufficient space
around each cylinder to pick it up. The cylinders
may have to be cut off to allow the patient to
close.
28. Restorative phase
• Block out the Screw access holes with cotton
pellets, wax or wooden cotton swab sticks
29. Restorative phase
• Intraoral Pick-up of Temporary Copings:
• Syringe of methyl methacrylate material is used to
pick up the temporary copings into the denture. Place
methyl methacrylate material around the temporary
copings and fill in the holes of the denture
30. Restorative Phase
• Remove Denture and Fill Voids and Gaps:
• Remove the cotton pellets and coping screws and remove the
denture from the mouth. The temporary copings will be picked up
into the denture. Fill any voids or gaps with additional acrylic or
ERA PickUp material.
31. Restorative Phase
• Finish and Polish the Denture:
• The Titanium Temporary Copings may be shortened with a
separating disk or bur to be flush with the denture base surface.
Also- be sure to cut off any cantilever behind the distal most
implants.
• Polish prosthesis using traditional techniques.
32. Restorative Phase
• Reseat the Denture:
Coronal and Apical views of the polished denture.
• The denture is reseated back into the mouth and the Coping Screws
tightened to 20Ncm using the Restorative Torque Wrench.
33. Restorative Phase
• Denture in Mouth:
• Completed denture seated in the mouth, facial and
Occlusal view. Screw access holes are blocked out with
a cotton pellet and filled with a composite resin.
34. Restorative Phase
• Denture in mouth:
• Completed denture seated in the mouth.
Same day Surgical and Restorative Procedure Completed:
Happy patient same day following the competition of the restorative procedure.
• The patient has undergone surgery and the conversion of the existing denture to
leave the same day with a fixed denture in place on the day of surgery.
Place floss in the hole in the Abutment Delivery Tool. This procedure is essential for safety purposes to prevent swallowing or inhaling the component.
The angled abutment is taken to the mouth and proper orientation is made. It should have an orientation that will allow screw access that will be parallel to the straight anterior implants. Note, the clinician may select a position that is best suited to the case. When the proper orientation is selected the Hex Driver is used to tighten the internal screw. The Hex Driver position will be parallel to the implant angle.
When the process of placing and tightening the abutment is complete the Abutment Delivery Tool is removed.
Place tapered abutments on the two anterior implants using the Hex Driver.
The included maxillary denture will represent a denture the patient is wearing or an immediate denture that has been made for delivery at the time of surgery. The position of the implant abutments is located and marked in the denture. Holes are then drilled in the denture to allow the Titanium Temporary Copings to extend into for picking them up in the denture conversion process. A clear duplicate denture is included to demonstrate this process.
Place the Titanium Temporary Copings on the abutments. When the 4 are in place they should be parallel.
Clear denture showing holes in correct position to allow space for the Temporary Titanium Copings.
The provisional and final prosthesis should be convex on the tissue surface area. In the maxillary ridge area it should lightly touch the tissue. It should NOT lap over the ridge.
The mandibular model has 5 straight implants. The model will be used to demonstrate the placement of Tapered Abutments, place indirect transfers (ACTIT) and make an impression.
The Hex Driver will fit into the Tapered Abutments.
Place abutments and tighten
Indirect Transfers (ACTIT) fit onto the Tapered Abutments. Lightly tighten the transfers but DO NOT over tighten these transfers.
After the impression, Tapered Abutment Replicas (ACTR) will be attached to the indirect transfers and the transfer is reseated in the impression.
Do not over tighten the transfers
Impression material is carefully placed around the transfers to get a good impression of the soft tissue and transfers. It is also important to get a good impression of the edentulous ridge.
Attach transfers to replicas and insert transfer back into impression.
A working cast can now be poured from the impression.