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A New Protocol for Immediate Functional Loading of Dental Implants By Thomas J. Balshi, DDS, FACP Protocol for Teeth in a DayTM Recognizing the significant advantages offered by immediate loading, the authors have developed a Teeth in a DayTM protocol. This protocol is best accomplished by a prosthodontist who surgically places dental implants or by a surgical and prosthodontic team working in the same facility. The prosthodontist fabricates a provisional restoration prior to surgery and then uses a series of standardized drills with copious irrigation to create an intimate implant receptor site. During creation of the osteotomy, bone quality and quantity at the site are assessed. If deemed sufficient to allow for good initial stability, one or more implants are placed. Selection of optimal implant diameters and thread design as well as self-tapping the implants may enable the operator to further increase the initial stability of the implant(s). Immediately after the last implant is placed, the Teeth in a DayTM restoration is created by converting a previously constructed provisional prosthesis into an immediate implant-supported nonremovable prosthesis. While this conversion is occurring in the laboratory, the abutments and prosthetic cylinders are connected to the implants. The prosthetic cylinders are then affixed to the provisional restoration intraorally using auto polymerizing acrylic resin. This technique allows for the placement of the implants in the proper position for each individual patient, followed by customization of the provisional restoration before surgical flap closure. Impressions for the final restoration can be taken either at the time of the initial surgery or at a later date. In either case, having the patient wear the restoration during the healing period gives the prosthodontist the opportunity to evaluate the esthetics, phonetics, and functional loading during the normal osseointegration healing period (three months in the mandible and five to six months in the maxilla.) Some microscopic distortion takes place at every stage of the prosthetic process, from making the impression to pouring the cast to casting the framework to applying the prosthetic veneering materials. The authors believe that using the all-acrylic splint as an impression splint eliminates one of these inaccuracies and creates an exceptionally accurate master cast. Furthermore, the prosthesis appears to have a splinting effect, locking the implants into place as the bone heals around them. Accepted by many biomechanical engineers, this theory will soon be tested through clinical studies. |
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All information is intended for your general knowledge only and is not a substitute for dental or medical advice or treatment for specific dental or medical conditions. You should seek prompt dental and medical care for any specific health issues. See Disclaimer Copyright 2009 Pi Dental Center (Prosthodontics Intermedica). |
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