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Maxillary bicuspids on both sides. Esthetic treatment with four implants.

Maxillary bicuspids on both sides. Esthetic treatment with four implants.

This is a simple case with plenty of bone, plenty of attached gingiva and quite good prosthetic space. So we might as well expect some esthetic results.

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However, it’s interesting to notice the difference in healing following the two different techniques chosen while stitching the flaps back in place.

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On the right side I simply faced both parts of the wound and sewed them up with simple and double stitches. The picture sequence is as of 0, 5 and 22 day period.

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On the left side I removed part of the gum prior to sewing both ends in place, letting the screws exposed. The healing, as we can see, is apparently healthier, no second surgery was needed to expose the healing screws, but the final result was the same on both sides. Basically, because the attached gingiva was generous on both, the gum biotype was thick and there was no need to lift up the flaps during surgery, as the bone was wide enough, too.
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These are the radiographic details. External hexagon 3.75 x13 and 10mm, . Front implant overlapped radiographically due to the pantomographic angle of exposure.

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Prosthetic phase
All except for the stump on 24, are screwed. 24 was done on stump because the intermaxillary gap was short. The antagonist 35 was also reduced in height, as you may see. When the occlusion is so well defined, I take partial casts, as they are more comfortable to obtain.
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The three screw chimneys are filled up with glass ionomer cement for this final result
I placed an overnight acrylic splint to prevent bruxism, too.
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X-Ray Splint

X-Ray Splint

An X-ray splint used in order to calibrate X-Ray images compared to the size of a known object, such as a round metal ball.   00296806 Why? because X-Ray images are usually distorted and don’t show the actual size of bone structures we need to measure. 00296805

The ball will appear round or ovoid in the X-Ray, but as it is  a round object, we know that the maximum diameter in the X-Ray has to match the diameter we already know from its real size.

Is it always necessary? No. If the bone structures we need to measure still have remaining teeth nearby, we can calibrate with those teeth. Therefore, it is most commonly used when none or few teeth remain in the jaws.

How is it made?

  1. We take impressions and make a cast of your jaw
  2. Balls are fixed on the cast in the desired position according to the estimated  position where we want to set the implants.  00296803
  3. A thermo-vacuum machine is used to melt a plastic layer and adapt it tightly over the cast.    00296804
  4. The splint is cut and conveniently adapted into the mouth   0024730300247305
  5. X-rays are taken with the splint in position and, then, calibrated

   TAC ferula rx 000 TAC ferula rx 001   TAC ferula rx 002