Level II: Advanced Implant Placement and Restoration

Course

Dr. David DaliseDr. Gary McCabe Ross

Impression Techniques

Impression Techniques

• Closed Tray• May be least accurate for multi unit cases.

– Stock Trays– Custom Trays

• Open Trays• May be more accurate for multi unit impressions• May be required due to implant/abutment angulations and path of insertion withdrawal.

– Stock Trays• Modifications required

– Custom Trays

Impression Materials

• PVS– Minor bone toxicity– Very stable– Multiple viscosities available

• Polyether– Toxic to bone– Very rigid– Very Stable– Most hydrophilic

• Rubber base– Toxic to bone– Relatively Stable– Slow set– Unpleasant taste to patient

• Others (hydrocolloids)– Least stable – Low tear strength– Least desirable to use due to limitations of material

Considerations, Complications, and Solutions

• What material and why– Use a material suitable to situation and operator familiarity

• Managing difficult patients or situations– High anxiety/apprehension

• IV sedation• Non-IV conscious sedation

– Gag reflex• Salt on tongue• Non-IV conscious sedation

– Medical complications• Have emergency kit in office and appropriate training for use for

doctor and staff• Bleeding

– Direct pressure– Vasoconstrictor – Vessel ligation– Appropriate referral/911

What to send to the Lab?

– Lab prescription • Detailed with all required prosthetic design and case

details.

– Appropriate and accurate impressions• Implant level • Abutment level

– Preoperative mounted models– Diagnostic wax up– Necessary restorative components for implant

• Implant analog• Impression analog• Necessary abutment screws• Temporary abutments

Pre Op X-ray

Periapical X-ray

#8 HS Bur

Pilot Drill w/out Drill Stops

Periapical X-ray

Tissue Punch

Removal of Tissue Plug

Countersink Drill

3.3mm Osteotome

3.5mm Osteotome

ISI 4mm x 12mm CB

Placement of ISI with Ultem Cap

Ratchet Wrench Seating ISI Implant

ISI Ratcheted to Final Seating

Torqued to 40+ N/Cm

Periapical X-ray

4.0 TRIP and 4.0 AC

TRIP “Snapped” Into Margin

THANK YOU

Questions?