The day of surgery, a full flap will be made, the ridge and tissue will be managed according to plan, and the implants will be placed.
Establishing Vdo
Be sure to establish the VDO prior to surgery.
Setup and Extraction
Bone Reduction
One of the most common reasons for the failure of these types of cases is due to a lack of accurate bone reduction. Below is an example of a case without enough posterior reduction.
Implant Placement
By tilting the two posterior implants, longer implants can be used. This increases bone-to-implant contact stability even in minimum bone volume and avoids vertical bone augmentation. In addition, the tilted implants can be anchored in better quality anterior bone, reducing cantilevers, and helps avoid important anatomical structures.
35 N·cm of insertion torque for immediate loading of prosthesis is required. A rule of thumb is to have 120 N·cm across the four implants to ensure implant stability, however it is important that none of the implants are spinners.
Multi-unit abutment placement
changing abutments
Torque Values
Nobel - straight 35 N⋅cm, angled 15 N⋅cm
Straumann - all 35 N⋅cm
BioHorizons - all 35 N⋅cm
Astra EV - 25 N⋅cm for both parts of the smartfix
Neoss - 20 N⋅cm
Zimmer - 30 N⋅cm
Biomet 3i - 35 N⋅cm
Ankylos - 25 N⋅cm
Suturing
Soft tissue contours are closed tightly around abutments, using a resorbable suture.
Once soft tissue is closed, the restorative team begins conversion of the immediate denture to the fixed prosthesis.
Conversion
At this stage, an Allure Dental Studio implant specialist, who has been present throughout the surgery, and the restorative doctor will complete the conversion process.
We will guide the restorative doctor through each step of the conversion, as well as provide laboratory equipment and restorative materials. If necessary, we can also provide all implant parts needed for the conversion (applicable fees apply). This should be requested ahead of time to ensure that the parts are present during surgery. Otherwise, it is expected that the parts will be provided by either the restorative doctor or the specialist.
Post-Op Care
These over-the-counter products are an example of those we recommend to patients to maintain a high standard of hygiene and care for their prosthesis. Some doctors provide these products as a courtesy to their patients. Allure Dental Studio partnered with Tepe Oral Health to develop a Post-Op Care Kit. In addition, patients should also use a water-pick or other similar product.
We recommend
- Antibiotics for one week.
- Peridex for two weeks.
- Water-Pick and super floss starting around the second week.
- Soft diet for four months - soft meats, cooked vegetables, soft fruits anything that the patient can smash with a fork.
- Never remove the temporary prosthesis during healing time, especially during the first six weeks.
These recommendations are based on common dental post-op and hygiene protocols.