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ePaper created 2017-03-17, 11:21:45 | version 1.38.0
| case report full mouth restoration Fig. 12: Postoperative retracted view biting. Fig. 13: Postoperative retracted view. Fig. 14: Postoperative maxillary occlusal view. Fig. 15: Postoperative mandibular occlusal view. Fig. 12 Fig. 13 Fig. 14 Fig. 15 for myself. Since the patient is sedated, a mouth prop, Logibloc (Common Sense Dental Products), is used to keep her mouth open. Logibloc’s unique design sta- bilises and comfortably supports the jaw while allow- ing unrestricted visual and physical access to the working area for the provider. Once the patient was completely sedated and anaes- thetised, the teeth were extracted in a systematic manner, working in sections at a time starting from the anterior maxillary teeth. Acting like a modified class I lever, the Physics Forceps (Golden Dental Solutions) were used to atraumatically extract the teeth with the goal of trying not to disturb the un- derlying bone. The beak of the forceps was placed on the lingual cervical portion of each tooth, where the soft bumper portion was placed on the buccal alveo- lar ridge at the approximate location of the muco- gingival junction. During the extraction process, the beak grasps the tooth and the bumper acts as the fulcrum. Extractions were accomplished with only slight wrist action in a buccal direction taking about 40 to 60 seconds each depending on the tooth mor- phology and density of bone. Once all the maxillary teeth were extracted, the alveolar crest was leveled 2–3 mm apically following the parameters set by the bone leveling guide with the AEU-7000 surgical motor/handpiece (Aseptico), so that the patient’s transition line from the ridge to the prosthesis would not be visible when the patient smiled. Once completed, the surgical drilling guide was inserted and the sites for the implants were initi- ated with the Hiossen-Osstem Guided kit (Fig. 6). In the upper arch, six 4.0 mm diameter ET III SA dental implants were placed in the areas of teeth #4, 6, 8, 9, 11 and 13 to support an All on Six restoration. The most distal implants were angled in order to avoid the max- illary sinus cavities and any augmentation in that area. In the lower arch, several different widths (3.5, 4.5 and 5.0 mm) of the ET III SA dental implants were used due to various widths of bone available in the remaining ridge. Here, the tooth areas that would have dental implant placement included #19, 22, 23, 25, 27 and 30. A baseline ISQ reading was taken of these implants utilising the Osstell ISQ unit. Since the initial readings were all above 65 and the quality of bone after level- ing was good, temporary Cylinders (Hiossen) were placed on the multiunit abutments (Hiossen) for im- mediate provisionalisation. Any residual areas around the implants or in the sockets were grafted with a putty blend of cortical mineralised and demineralised bone grafting material to optimise the area for regen- eration. Primary closure was achieved by suturing the tissue with resorbable sutures. The immediate provisional restoration was tried in to insure a passive fit over the temporary abutments (Fig. 7). Once confirmed, block-out material was placed to avoid the restoration from locking on and chairside hard denture reline material (Rebase II, Tokuyama) placed within recesses around the tempo- rary abutments to pick up the restoration. After the material completely set, the immediate provisional restoration was removed and any access material trimmed and polished with the Torque Plus (Aseptico) lab handpiece and acrylic bur (Komet). A similar series of steps was utilised for the mandibular arch. In fact, the ISQ values were even higher due to the type and quality of bone present in the patient’s mandible. At this point, a Panorex was taken to confirm the placement and position of the dental implants with 22 CAD/CAM 1 2017