Restoration of a Multi-Implant Case: Tips and Guidelines for Impression Taking and Cementation?

Really? You're treatment planning one of the most difficult things we can do in dentistry and you're asking about how to make and impression and seat the bridges? What about surgical guide fabrication,implant provisionalization, vertical dimension issues, lip support issues, material selection? Hopefully you're not leaving these critical questions to your surgeon or lab technician. These decisions are the restorative dentist's responsibility so if you have never done this before, this is not the case to start with. Do you really want to take on a $30+thousand dollar liability? Would you want someone practicing on you and asking you to spend that kind of money? Please, refer this to a prosthodontist and observe how he or she treatment plans and finishes the treatment. You will sleep better

First lets address single roundhouse bridge vs 3 separate bridges. The direction of loading of the anterior maxillary teeth is a splaying motion with the teeth/implants being pushed in a facial direction. and when we combine that with lower density bone found in the maxilla it is IMHO better to do a roundhouse bridge to get cross arch stabilization and less chance of crestal bone loss.

Gregory is right it's the application of basic physics. The other considerations such as vertical dimension are also important. The easiest solution is a cone beam analysis and a preplanned surgical guide stent ; assuming everything else is in order(e.g sufficient bone) then go for it.

Dr. Johnson, you seem a bit frustrated. Unfortunately most of these cases do get tx planned by the omfs and I totally agree, this is "bass ackwards". This does look as if it's not gonna go so well. A good prosthodontist would spend three or four visits just getting the splint made for the surgeon. Unfortunately everyone is in such a big hurry, they forget about the one, laying supine in their office. Bv

Misch advocates segmented bridges for the sake of repair. A metal Impresson tray will yield less distortion than a plastic tray. The case should have a classic work up (face bow, Dx wax up, mounted study models, provisional bridge).

Dear fellow doctor, I appreciate that you asked a very concrete question how to take impression and how to cement a long span bridge? First of all there is no sense to send the patient to the prosthodontist because you can make it may be even better than him. Forget about taking the final impression with close or open tray technique, it doesn't work. What you have to use is The G-Cuff impression technique. That method will solve you the two problems, the accuracy of the impression creating a passive fit and the cementation as well. The work flow is the following: 1 Take a preliminary impression of your implants using a simple close tray technique. 2 send it to the lab for custom abutments or customization of the standard abutments. ask the lab to fabricate a nice hygienic temporary restoration and a placement jig for the abutments(to save your time) 3 place the custom abutments permanently with the cuffs. 4 take impression G-Cuff technique and remove the cuffs. 5 place the temp which is going to create a healthy soft tissue profile for an easy and clean cementation of the final restoration. I don't want to advertise please google yourself. there is stuff on youtube that you can watch. Good luck

YOU TOO CAN PERFORM DENTAL SURGERY AND RESTORATIVE TREATMENT . Go to U-Tube University. Do you suggest he watch it whilst he's performing the procedure? I thought this site was a means of getting experts together and kicking around ideas and philosophies!! Can someone explain how to do a microvascular free flap, screw a bunch of fellowship trained vascular surgeons. Bv

Without studying the effects of the collateral damage associated with electrosurgical removal of impants, I would suggest removing the implant with sharp, rotary instrumentation. Oral bisphosphonates cause significant damage ( long term ), so we can only imagine what the long term ill-effect of thermal damage can cause. I'm just suggesting using "evidenced based" medicine. Bv