Written by George J. Papasikos, DMD, and James F. Skiba, DDS Monday, 30 April 2007 19:00
This article describes a case that in-volved placement of 6 implants and a prosthesis in a completely edentulous patient. The procedure was performed utilizing NobelGuide software (Nobel Biocare), and the technique is trademarked as Teeth-in-an-Hour (Nobel Biocare). Utilizing a computed tomography (CT) scan and virtual software we were able to plan the placement of implants, fabricate a surgical template that would allow transfer of the plan to the oral cavity, and place a provisional prosthesis all in the same day. (Note that depending on the case, the clinician also has the option of placing a final prosthesis.)
Figure 1. The patient, a 60-year-old female, was edentulous in the maxillary arch.
|Figures 2a and 2b. Virtual software was used to plan implant position and design of the prosthesis.|
|Figure 3. The information was e-mailed to Belgium, where a surgical template and a prosthesis were fabricated.|
Figure 4. The surgical template was inserted with pins for stability.
Figure 5. Prefabricated drill guides were utilized for flapless implantation of 6 fixtures.
|Figure 6. The template was removed, and the prosthesis was placed with special abutments that have the ability to adjust.|
|Figure 7. The patient presented edentulous and left with a fixed prosthesis. Total treatment time was approximately 2 to 3 hours.|
The patient was a 60-year-old female who was edentulous in the maxillary arch (Figure 1). After an initial examination and consultation the patient was referred for a CT scan of her maxilla. At this time, the patient wore a radiographic template provided by the restorative dentist.
Upon receipt of the scan we planned the position of the implants with our restorative colleague, as well as the design of the prosthesis. This was done utilizing the virtual software (Figures 2a and 2b). The information was e-mailed to the software company’s headquarters in Sweden, where a surgical template was fabricated (Figure 3). The prosthesis was then fabricated by Kuwata Pan Dent, an authorized Nobel Biocare Laboratory.
The surgical template was inserted with pins for stability (Figure 4). Prefabricated drill guides were utilized for flapless implantation of 6 fixtures (Figure 5). The template was then removed, and the prosthesis was placed with special abutments that have the ability to adjust by expanding laterally (Figure 6).
The patient presented edentulous and left with a fixed prosthesis (Figure 7). Total treatment time was approximately 2 to 3 hours.
ADVANTAGES OF THIS PROCEDURE
• Reduced treatment time compared to the traditional protocol.
• Minimally invasive surgery.
• Fewer postoperative complications.
• Prosthesis (temporary or final) seated on the same day with accuracy.
If 6 to 8 implants are placed in a completely edentulous maxilla and loaded at the time of surgery with cross-arch stabilization, the literature has shown that osseointegration occurs. Cross-arch stabilization using a well-fitted prosthesis allows loading of implants immediately. Certain criteria, such as good bone quality, a well-fitted prosthesis, and a balanced occlusion, must be met.
Postoperative instructions include a soft diet for 4 to 6 weeks and to avoid chewing anything hard or tearing into food. At 3 to 4 months implant integration is tested and a final prosthesis can be made if needed.
This procedure is appropriate for anyone who is missing one tooth or all teeth. The technique can be used for the partially edentulous as well as fully edentulous maxilla or mandible.
Recently, there has been an increased demand from the public for this procedure. Currently, numerous cases are being prepared and treatment planned in our offices. Our experience has been excellent.
A special thanks to our periodontal colleague, Dr. Philip Kang of Montclair, NJ, and Kuwata Pan Dent Laboratory in Cedar Knolls, NJ, for their expertise and guidance in the treatment of our patient.
Dr. Papasikos received his DMD from Fairleigh Dickinson University School of Dentistry in 1978 and completed a postgraduate residency in periodontics at The University of Medicine and Dentistry of New Jersey in 1983. He is a Fellow of the AGD and has served as chief of periodontics, prosthodontics, and endodontics at Mountainside Hospital in New Jersey. He is an attending at the dental residency programs at Mountainside and Morristown Memorial hospitals in New Jersey. Dr. Papasikos practices periodontics and implant dentistry with Dr. Philip Kang, with offices in Montclair and Bedminster, NJ. He can be reached at (973) 783-2300 or
Dr. Skiba graduated from New York University College of Dentistry in 1976. He completed a general practice residency at Mountainside Hospital in Montclair, NJ, from 1976 through 1978, and his postgraduate training in prosthodontics at The University of Medicine and Dentistry of New Jersey (UMDNJ) in 1980. He is a co-author of Classification Systems for Completely Edentulous, Partially Edentulous, and Completely Dentate Patients, which have been published in the Journal of Prostho-dontics. He is a member of the American College of Prosthodontists and The American Academy of Fixed Prosthodontics. Dr. Skiba maintains a private practice limited to prosthodontics with an in-house dental laboratory facility in Montclair, NJ. Previously he was a clinical assistant professor at UMDNJ in the department of fixed prosthodontics. He has lectured to the postgraduate students in prosthodontics at UMDNJ and provides the didactic education in prosthodontics for the general practice dental residency at Mountainside Hospital. He can be reached at (973) 746-7037.
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