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Teeth in a Day with Digital Workflow

Full arch immediately installed fixed bridge with SmartFix® concept on OmniTaper implants 

64 year old male patient that was a fit and otherwise healthy non smoker. He presents with failing partially dentate upper dentition with underlying periodontal disease. After extraction a full arch immediate temporary prosthesis was placed on 4 OmniTaper EV Implants. 4 months later a digitally designed Atlantis Suprastructure using the SmartFix concept together with a Zirconia bridge was placed.

1. Initial situation with the partially dentate maxilla. The missing teeth were being replaced with a partial removable prosthesis.

2. Radiographs confirmed the extent of the periodontal disease. The remaining upper teeth were judged to be unsavable but with sufficient underlying bone for immediate implant placement and immediate temporary fixed restoration. Three lower molar extractions and periodontal specialist care was planned.

3. A new full immediate upper prosthesis was fabricated in advance of surgery for planned conversion to a temporary screw retained fixed implant supported restoration on the day of surgery.

4. A simple tissue supported surgical guide was also constructed closely based on the provisional restoration.

5. On the day of surgery, under local anaesthesia, the remaining upper teeth were removed and the residual alveolar ridge was smoothed and shaped to receive four Dentsply Sirona OmniTaper EV implants suitably positioned to support the immediate temporary fixed restoration.

6. The OmniTaper EV Implants Ø3.8mm are designed to develop favourable primary stability to facilitate the planned immediate full arch fixed restoration.

7. A favourable distribution of implants was obtained with good anterior/posterior spread and angulation of the distal implants according to the Dentsply Sirona SmartFix concept. The TempBase driver mounts were then removed.

8. Multibase Abutment EV were fitted with straight abutments used for the anterior two implants and 17 degree angled for the two distal implants. Good parallel alignment was achieved.

9. The abutments were aligned for optimal utilisation for the full arch screw retained immediate restoration.

        10. Retention sleeves were attached with the precaution of silicone collars gingivally and PTFE blocking at top to prevent excess acrylic resin being extruded subgingivally or into the retention sleeve screws.

11. The prosthesis was secured intraorally with cold cure acrylic resin and on setting the retention sleeve screws were disengaged allowing removal of the prosthesis with retention sleeves now attached.

12. Our onsite technician finished the conversion with trimming and polishing. The underside is profiled to be smoothly convex to facilitate good oral hygiene. The screw retained temporary prosthesis is fitted. The patient is kept under review with light diet advised.

13. After 4 months the patient returns for intra oral scans for the definitive restoration using PrimeScan and a model free protocol. The temporary prosthesis is scanned in situ.

14. The Dentsply Sirona digital workflow is followed by using Atlantis IO FLO-S.

15. The temporary prosthesis is confirmed as having satisfactory tooth positions both aesthetically and functionally and is therefore scanned to provide guidance for the set-up of the definitive restoration. 

16. The final restoration is fabricated comprising the Atlantis BridgeBase with a zirconia milled structure luted in the laboratory.

17. The radiograph showing the fitted definitive restoration at completion of treatment.

18. The final upper fixed restoration fitted with excellent aesthetic and functional rehabilitation for the patient.

Written by Dr Anthony Bendkowski

A specialist in oral surgery in practice limited to implant reconstructive surgery

November 14, 2023

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