sky fast and fixed october2008 with annotations gb v1

7/27/2019 SKY Fast and Fixed October2008 With Annotations GB v1

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SKY fast & fixed

ExtractionImplantation

Immediate fixed bridge


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Problem

Patient has residual teeth not worth preserving

Patient is afraid of losing all his teeth

Patient refuses to wear a conventional denture


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Previous solutions

Augmentations

Increased risk of complications

Immediate loading is not possible,

i.e. patient will be edentulous for

at least 6 months

Normally several surgical

interventions are required


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Previous solutions

Implant retained dentures

No posterior support

Immediate restoration in the lower jaw

only possible for rigid connection

Ledermann type -

Does not fulfill the patient's wish


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Solution

An angled implant (approx. 35) ensures

posterior support of the prosthetic restoration

so that a fixed temporary bridge can be

immediately integrated.

MaloP et al.

All on four immediate function concept with Brnemark system implants

for completely edentulous manandibles: A 1 year retrospective clinical study.

Clin Implant dental Res 2005; 7(1):88-94


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Solution

Extraction

Implant insertion


Owing to the differences in the bone

morphology of the jaws, this type of

restoration should be supported

by 6 implants in the UJ

by 4 implants in the LJ


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Solution

This method allows to protect the critical

anatomical regions:

Dr. Frank Kistler und Dr. Steffen Kistler,

all-on-four, neue Philosophie bei der implantologischen Versorgung im zahnlosen Kiefer.

BZB/BLZK & KZVB, April 2005

Apracio C, Perales P, Rangert B.

Tilted to maxillary sinus grafting: A clinical, radiologic and Periotest study.

Clin Implant Dent Relat Res 2001; 3:39-49

Maxillary sinus and nasal cavity in the UJ

Mandibular canal in the LJ


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Solution

Enhanced biomechanical stability

Time saved

Reduction of work amount and costs

Implantation in the local bone without

augmentation:

Fischer K, Sternberg T.

Early loading of ITI implants supporting a maxillary full-arch prosthesis: one Year data of a prospective,

randomised study. Int J Oral Maxillofac Implants 2004; 19:374-381

Tarnow D P et al:

Immediate loading of threaded implant at stage-1 surgery in edentulous arches: Ten Conscutive

case reports with 1-to 5-years data. Int J Oral Maxillofac Implants 1997; 12:319-324


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Preconditions

Team concept:

Experienced implantologist

with profound anatomical and

surgical know-how

Flexible dental technician

in the vicinity


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Clinical protocol

Initial situation

Dr. Sierch, Augsburg Dr. Sierch, Augsburg


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Clinical protocol

Planning

Laboratory Stachulla & Liedtke Laboratory Stachulla & Liedtke


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3 FRP screws

for the fixation of the drilling template

Clinical protocol

Planning



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Transfer of the positions of the FRP

screws to the model

Clinical protocol

Planning



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Clinical protocol

PlanningX-ray template and 3D planning

Dr. Sierch, Augsburg



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Clinical protocol

Surgery

Drilling template fixedon the FRP screws

and placement of the implants



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Clinical protocol

SurgeryFinal OPG (x-ray image)

implants and FRP screws

Dr. Sierch, Augsburg


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Clinical protocol

Prosthetics - Laboratory

Impression Model with copings and index



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Clinical experience

Temporary restoration

on the day of surgery

Definitive restoration

after six months


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Clinical experience

Temporary restoration

on the day of surgery

Definitive restoration

after one year


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Clinical experience


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Course of treatment

Step by step

SKY fast & fixed

ExtractionImplantation



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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Exposure of the

mandibular nerve

Procedure Example of lower jaw

II


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Determination of the mid-line

Procedure example of lower jaw

II

II


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Positions of

the vertical implants

determine distance "a"


aa

aa

III


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Posterior implants have

almost the same distance

as the anterior ones


b

b

bb


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Drilling the implant cavity

pay attention to the

mandibular nerve


b

b

bb


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Implant cavities

prepared for insertion


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Insertion of

the abutments


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Implants in situ


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Screwing on

the impression copings


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

breciform transparent

+ brecision heavybody

allow quick and precise

fabrication of the model since

shrinkage is stopped alreadyafter a short period.


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Model fabrication

Thixo-Rockis the ideal

material for model fabrication,

features very low expansion

and can be processed after ashort period.


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

The prosthetic copings are

screwed onto the laboratory

analogs.

Then the prepared denture

is adapted.


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

With the help of the index,

the prefabricated denture

is ground at the implant

positions

A prosthetic coping isintegrated (polymerized)

(coping is sealed with

auxiliary element)

A spacer is attached

to the other copings


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

Denture prepared for correct

placement in the mouth


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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16

The remaining copings are

polymerized whilst avoiding

any stress and ensuring

precise fit.


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The temporary restoration

is finished and inserted in

the patient's mouth

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16


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Clinical caseInitial situation

Dr. Bayer, Landsberg


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Clinical caseExtraction



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Clinical caseSoft tissue management



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Clinical caseSoft tissue management



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Clinical caseBone management



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Clinical caseBone management



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Clinical caseExposure of the nerve



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Clinical caseImplant positions



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Clinical caseImplant insertion



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Clinical caseAbutment insertion



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Clinical caseImpression



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Prosthetic procedure

Dental technician should be present

during impression and bite registration

Temporary restoration prepared to

be adapted to the clinical situation


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Master dental technician Adler, Landsberg


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Model fabrication Integration of the prosthetic coping intothe prepared bridge using the index



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Silicone tubes as spacerson the prosthetic copings Polymerization of a prosthetic copingdirectly into the bridge



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Bridge prepared

for try-in in the mouth



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Integration temporary restoration

Remaining prosthetic copings

are fixed in the bridge.



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Bridge completely finished



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Integration temporary restoration



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Fabrication of

the temporary restorationwith visio.lign

SKY fast & fixed

Extraction

Implantation



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Impression copings are removed

Fabrication of the temporary restoration with visio.lign



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Prosthetic copings are screwed on



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The height of the prosthetic copingsis checked in the articulator and the

copings are shortened if necessary




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The set-up with visio.lign veneers




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The set-up with the visio.lign veneersis completed with wax




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A key is prepared with Haptosil




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The sandblasted veneersare conditioned with visio.link




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The silicone tubes are attachedand serve as spacers.



One screw canal is sealed.


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Accurate fit of the matrix is checked

on the model




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breformance is poured into the matrix.



After hardening, the spacers are removed.


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The recesses for the prosthetic copingsare expanded with the matrix location drill.



Additionally, retentions for the light-curingresin are ground / milled.


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The bridge is safely fixed withthe polymerized prosthetic coping



The remaining prosthetic copingsare integrated into the bridge using

light-curing composite


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The composite is polymerized.



The bridge is removed and completed


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The use of the visio.lign veneers allows

the fabrication of a temporaryrestoration within 3 hours without any

preliminary work




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Success:Data from the Landsberg field study

58 completely documented individual cases

Observation period after completion

of treatment: at least 9 months

Total number of 312 implant restorations

No case of complete failure

Total of 4 implant losses

3 of these were terminal implants after

fracture of the temporary restoration

Date: December 2007

Extraction

Implant insertion



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Advantages - dentist

Making optimal use of the local bone

Excellent load distribution for the restoration

thanks to posterior support

No investment costs for material / tools

High-quality temporary restoration

reduces work amount for the practice

No re-basing

Patient has time to select

his definitive restoration

Extraction

Implant insertion



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Advantages

Good long-term prognosis since

augmentations that entail risks

can be avoided

Extended period until the

fabrication of the definitive restoration

All options for the definitive restoration

are available

Satisfied patients = increased publicity


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Advantage for the patient

Patient will leave the practice

with a fixed restoration

Palate-free restoration,

also for the temporary

No pressure spots caused by the temporary

No second (follow-up) surgery required

Clearly defined costs fixed price

Implant insertionExtraction Immediate fixed bridge

Oral situation upon entering

the practice 9 a.m.Patient upon leaving the practice

on the same day 3 p.m.


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Patient marketing

Solutions 10,000


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Thank you very much for your attention.

sky fast and fixed october2008 with annotations gb v1

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