SKY Fast and Fixed October2008 With Annotations GB v1

SKY fast & fixed
Extraction
Implantation Immediate fixed bridge
Problem
Patient has residual teeth not worth preserving
Patient is afraid of losing all his teeth

Patient refuses to wear a conventional denture
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
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
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
Solution
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 Extraction Implant insertion Immediate fixed bridge
Solution
This method allows to protect the critical anatomical regions:
Maxillary sinus and nasal cavity in the UJ Mandibular canal in the LJ
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
Solution
Implantation in the local bone without augmentation:
Enhanced biomechanical stability Time saved Reduction of work amount and costs
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
Preconditions
Team concept: Experienced implantologist with profound anatomical and surgical know-how Flexible dental technician in the vicinity
Clinical protocol Initial situation
Dr. Sierch, Augsburg
10
Clinical protocol Planning
Laboratory Stachulla & Liedtke
11
3 FRP screws for the fixation of the drilling template
12
Transfer of the positions of the FRP screws to the model
13

X-ray template and 3D planning
14
Clinical protocol Surgery
Drilling template fixed on the FRP screws
and placement of the implants
15
Clinical protocol Surgery

Final OPG (x-ray image) implants and FRP screws
16
Clinical protocol Prosthetics - Laboratory
Impression
Model with copings and index
17
Clinical experience
Temporary restoration on the day of surgery
Definitive restoration after six months
18
Clinical experience
Temporary restoration on the day of surgery
Definitive restoration after one year
19
Clinical experience
20
SKY fast & fixed

Extraction
Course of treatment Step by step
21
Procedure Example of lower jaw

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Exposure of the mandibular nerve
22
Procedure example of lower jaw

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Determination of the mid-line

II
23

01 02 a 03 a III 04 05 06 07 08 09 10 11 12 13 14 15 16
Positions of the vertical implants determine distance "a"
24

01 02 03 b b 04 05 06 07 08 09 10 11 12 13 14 15 16
Posterior implants have almost the same distance as the anterior ones
25

01 02 03 b b 04 05 06 07 08 09 10 11 12 13 14 15 16
Drilling the implant cavity pay attention to the mandibular nerve
26

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Implant cavities prepared for insertion
27

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Insertion of the abutments
28

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Implants in situ
29

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Screwing on the impression copings
30

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 already after a short period.
31

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Model fabrication
Thixo-Rock is the ideal material for model fabrication, features very low expansion and can be processed after a short period.
32

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.
33

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 is integrated (polymerized) (coping is sealed with auxiliary element) A spacer is attached to the other copings
34

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Denture prepared for correct placement in the mouth
35

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.
36

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
The temporary restoration is finished and inserted in the patient's mouth
37
Clinical case Initial situation
Dr. Bayer, Landsberg
38
Clinical case Extraction
39
Clinical case Soft tissue management
40
Clinical case Soft tissue management
41
Clinical case Bone management
42
Clinical case Bone management
43
Clinical case Exposure of the nerve
44
Clinical case Implant positions
45
46
47
48
49
50
Clinical case Implant insertion
51
52
53
54
Clinical case Abutment insertion
55
Clinical case Impression
56
Prosthetic procedure
Dental technician should be present during impression and bite registration
Temporary restoration prepared to be adapted to the clinical situation
57
Master dental technician Adler, Landsberg
58
59
Model fabrication
Integration of the prosthetic coping into the prepared bridge using the index
60
Silicone tubes as spacers on the prosthetic copings
Polymerization of a prosthetic coping directly into the bridge
61
62
Bridge prepared for try-in in the mouth
63
Integration temporary restoration

Remaining prosthetic copings are fixed in the bridge.
64
Bridge completely finished
65
Integration temporary restoration
Master dental technician Adler, Landsberg 66
Dr. Bayer, Landsberg 67
SKY fast & fixed

Extraction
Fabrication of the temporary restoration with visio.lign
68
Impression copings are removed
69
Prosthetic copings are screwed on
70
The height of the prosthetic copings is checked in the articulator and the copings are shortened if necessary
71
The set-up with visio.lign veneers
72
The set-up with the visio.lign veneers is completed with wax
73
A key is prepared with Haptosil
74
The sandblasted veneers are conditioned with visio.link
75
The silicone tubes are attached and serve as spacers.
One screw canal is sealed.
76
Accurate fit of the matrix is checked on the model
77
breformance is poured into the matrix.
After hardening, the spacers are removed.
78
The recesses for the prosthetic copings are expanded with the matrix location drill.
Additionally, retentions for the light-curing resin are ground / milled.
79
The bridge is safely fixed with the polymerized prosthetic coping
The remaining prosthetic copings are integrated into the bridge using light-curing composite
80
The composite is polymerized.
The bridge is removed and completed
81
The use of the visio.lign veneers allows the fabrication of a temporary restoration within 3 hours without any preliminary work
82
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 Immediate fixed bridge
83
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 Immediate fixed bridge
84
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
85
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
Extraction
Implant insertion
Immediate fixed bridge
Oral situation upon entering the practice 9 a.m.
Patient upon leaving the practice on the same day 3 p.m.
86
Patient marketing
> 10,000
Solutions 5,000 10,000 Solutions < 5,000
87
Thank you very much for your attention.
88

SKY Fast and Fixed October2008 With Annotations GB v1

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SKY Fast and Fixed October2008 With Annotations GB v1

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SKY fast & fixed

Patient has residual teeth not worth preserving

Patient is afraid of losing all his teeth

Clinical protocol Initial situation

Dr. Sierch, Augsburg

Dr. Sierch, Augsburg

Clinical protocol Planning

Laboratory Stachulla & Liedtke

Laboratory Stachulla & Liedtke

Clinical protocol Planning

Laboratory Stachulla & Liedtke

Laboratory Stachulla & Liedtke

3 FRP screws for the fixation of the drilling template

Clinical protocol Planning

Laboratory Stachulla & Liedtke

Laboratory Stachulla & Liedtke

Transfer of the positions of the FRP screws to the model

Clinical protocol Planning

Dr. Sierch, Augsburg

Dr. Sierch, Augsburg

Dr. Sierch, Augsburg

Clinical protocol Surgery

Dr. Sierch, Augsburg

Dr. Sierch, Augsburg

Drilling template fixed on the FRP screws

and placement of the implants

Clinical protocol Surgery

Dr. Sierch, Augsburg

Clinical protocol Prosthetics - Laboratory

Laboratory Stachulla & Liedtke

Laboratory Stachulla & Liedtke

Model with copings and index

Temporary restoration on the day of surgery

Definitive restoration after six months

Temporary restoration on the day of surgery

Definitive restoration after one year

SKY fast & fixed

Course of treatment Step by step

Procedure Example of lower jaw

Exposure of the mandibular nerve

Procedure example of lower jaw

Determination of the mid-line

Procedure example of lower jaw

Positions of the vertical implants determine distance "a"

Procedure example of lower jaw

Procedure example of lower jaw

Drilling the implant cavity pay attention to the mandibular nerve

Procedure example of lower jaw

Implant cavities prepared for insertion

Procedure example of lower jaw

Insertion of the abutments

Procedure example of lower jaw

Procedure example of lower jaw

Screwing on the impression copings

Procedure example of lower jaw

breciform transparent + brecision heavybody

Procedure example of lower jaw

Procedure example of lower jaw

The prosthetic copings are screwed onto the laboratory analogs.

Procedure example of lower jaw

Procedure example of lower jaw

Denture prepared for correct placement in the mouth

Procedure example of lower jaw