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SKY fast & fixed
ExtractionImplantation
Immediate fixed bridge
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Problem
Patient has residual teeth not worth preserving
Patient is afraid of losing all his teeth
Patient refuses to wear a conventional denture
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Previous solutions
Augmentations
Increased risk of complications
Immediate loading is not possible,
i.e. patient will be edentulous for
at least 6 months
Normally several surgical
interventions are required
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Previous solutions
Implant retained dentures
No posterior support
Immediate restoration in the lower jaw
only possible for rigid connection
Ledermann type -
Does not fulfill the patient's wish
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Solution
An angled implant (approx. 35) ensures
posterior support of the prosthetic restoration
so that a fixed temporary bridge can be
immediately integrated.
MaloP et al.
All on four immediate function concept with Brnemark system implants
for completely edentulous manandibles: A 1 year retrospective clinical study.
Clin Implant dental Res 2005; 7(1):88-94
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Solution
Extraction
Implant insertion
Immediate fixed bridge
Owing to the differences in the bone
morphology of the jaws, this type of
restoration should be supported
by 6 implants in the UJ
by 4 implants in the LJ
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Solution
This method allows to protect the critical
anatomical regions:
Dr. Frank Kistler und Dr. Steffen Kistler,
all-on-four, neue Philosophie bei der implantologischen Versorgung im zahnlosen Kiefer.
BZB/BLZK & KZVB, April 2005
Apracio C, Perales P, Rangert B.
Tilted to maxillary sinus grafting: A clinical, radiologic and Periotest study.
Clin Implant Dent Relat Res 2001; 3:39-49
Maxillary sinus and nasal cavity in the UJ
Mandibular canal in the LJ
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Solution
Enhanced biomechanical stability
Time saved
Reduction of work amount and costs
Implantation in the local bone without
augmentation:
Fischer K, Sternberg T.
Early loading of ITI implants supporting a maxillary full-arch prosthesis: one Year data of a prospective,
randomised study. Int J Oral Maxillofac Implants 2004; 19:374-381
Tarnow D P et al:
Immediate loading of threaded implant at stage-1 surgery in edentulous arches: Ten Conscutive
case reports with 1-to 5-years data. Int J Oral Maxillofac Implants 1997; 12:319-324
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Preconditions
Team concept:
Experienced implantologist
with profound anatomical and
surgical know-how
Flexible dental technician
in the vicinity
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Clinical protocol
Initial situation
Dr. Sierch, Augsburg Dr. Sierch, Augsburg
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Clinical protocol
Planning
Laboratory Stachulla & Liedtke Laboratory Stachulla & Liedtke
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3 FRP screws
for the fixation of the drilling template
Clinical protocol
Planning
Laboratory Stachulla & Liedtke Laboratory Stachulla & Liedtke
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Transfer of the positions of the FRP
screws to the model
Clinical protocol
Planning
Laboratory Stachulla & Liedtke Laboratory Stachulla & Liedtke
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Clinical protocol
PlanningX-ray template and 3D planning
Dr. Sierch, Augsburg
Dr. Sierch, Augsburg Dr. Sierch, Augsburg
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Clinical protocol
Surgery
Drilling template fixedon the FRP screws
and placement of the implants
Dr. Sierch, Augsburg Dr. Sierch, Augsburg
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Clinical protocol
SurgeryFinal OPG (x-ray image)
implants and FRP screws
Dr. Sierch, Augsburg
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Clinical protocol
Prosthetics - Laboratory
Impression Model with copings and index
Laboratory Stachulla & Liedtke Laboratory Stachulla & Liedtke
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Clinical experience
Temporary restoration
on the day of surgery
Definitive restoration
after six months
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Clinical experience
Temporary restoration
on the day of surgery
Definitive restoration
after one year
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Clinical experience
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Course of treatment
Step by step
SKY fast & fixed
ExtractionImplantation
Immediate fixed bridge
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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Exposure of the
mandibular nerve
Procedure Example of lower jaw
II
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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Determination of the mid-line
Procedure example of lower jaw
II
II
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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Positions of
the vertical implants
determine distance "a"
Procedure example of lower jaw
aa
aa
III
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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Posterior implants have
almost the same distance
as the anterior ones
Procedure example of lower jaw
b
b
bb
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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Drilling the implant cavity
pay attention to the
mandibular nerve
Procedure example of lower jaw
b
b
bb
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Procedure example of lower jaw
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Implant cavities
prepared for insertion
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Insertion of
the abutments
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Implants in situ
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Screwing on
the impression copings
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
breciform transparent
+ brecision heavybody
allow quick and precise
fabrication of the model since
shrinkage is stopped alreadyafter a short period.
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Model fabrication
Thixo-Rockis the ideal
material for model fabrication,
features very low expansion
and can be processed after ashort period.
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
The prosthetic copings are
screwed onto the laboratory
analogs.
Then the prepared denture
is adapted.
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
With the help of the index,
the prefabricated denture
is ground at the implant
positions
A prosthetic coping isintegrated (polymerized)
(coping is sealed with
auxiliary element)
A spacer is attached
to the other copings
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
Denture prepared for correct
placement in the mouth
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Procedure example of lower jaw
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
The remaining copings are
polymerized whilst avoiding
any stress and ensuring
precise fit.
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Procedure example of lower jaw
The temporary restoration
is finished and inserted in
the patient's mouth
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
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Clinical caseInitial situation
Dr. Bayer, Landsberg
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Clinical caseExtraction
Dr. Bayer, Landsberg
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Clinical caseSoft tissue management
Dr. Bayer, Landsberg
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Clinical caseSoft tissue management
Dr. Bayer, Landsberg
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Clinical caseBone management
Dr. Bayer, Landsberg
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Clinical caseBone management
Dr. Bayer, Landsberg
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Clinical caseExposure of the nerve
Dr. Bayer, Landsberg
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Clinical caseImplant positions
Dr. Bayer, Landsberg
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Clinical caseImplant positions
Dr. Bayer, Landsberg
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Clinical caseImplant positions
Dr. Bayer, Landsberg
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Clinical caseImplant positions
Dr. Bayer, Landsberg
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Clinical caseImplant positions
Dr. Bayer, Landsberg
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Clinical caseImplant positions
Dr. Bayer, Landsberg
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Clinical caseImplant insertion
Dr. Bayer, Landsberg
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Clinical caseImplant insertion
Dr. Bayer, Landsberg
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Clinical caseImplant insertion
Dr. Bayer, Landsberg
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Clinical caseImplant insertion
Dr. Bayer, Landsberg
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Clinical caseAbutment insertion
Dr. Bayer, Landsberg
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Clinical caseImpression
Dr. Bayer, Landsberg
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Prosthetic procedure
Dental technician should be present
during impression and bite registration
Temporary restoration prepared to
be adapted to the clinical situation
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Prosthetic procedure
Master dental technician Adler, Landsberg
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Prosthetic procedure
Master dental technician Adler, Landsberg
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Prosthetic procedure
Model fabrication Integration of the prosthetic coping intothe prepared bridge using the index
Master dental technician Adler, Landsberg
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Prosthetic procedure
Silicone tubes as spacerson the prosthetic copings Polymerization of a prosthetic copingdirectly into the bridge
Master dental technician Adler, Landsberg
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Prosthetic procedure
Master dental technician Adler, Landsberg
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Prosthetic procedure
Bridge prepared
for try-in in the mouth
Master dental technician Adler, Landsberg
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Integration temporary restoration
Remaining prosthetic copings
are fixed in the bridge.
Dr. Bayer, Landsberg
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Prosthetic procedure
Bridge completely finished
Master dental technician Adler, Landsberg
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Integration temporary restoration
Master dental technician Adler, Landsberg
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Dr. Bayer, Landsberg
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Fabrication of
the temporary restorationwith visio.lign
SKY fast & fixed
Extraction
Implantation
Immediate fixed bridge
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Impression copings are removed
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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Fabrication of the temporary restoration with visio.lign
Prosthetic copings are screwed on
Master dental technician Adler, Landsberg
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The height of the prosthetic copingsis checked in the articulator and the
copings are shortened if necessary
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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The set-up with visio.lign veneers
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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The set-up with the visio.lign veneersis completed with wax
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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A key is prepared with Haptosil
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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The sandblasted veneersare conditioned with visio.link
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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The silicone tubes are attachedand serve as spacers.
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
One screw canal is sealed.
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Accurate fit of the matrix is checked
on the model
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
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breformance is poured into the matrix.
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
After hardening, the spacers are removed.
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The recesses for the prosthetic copingsare expanded with the matrix location drill.
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
Additionally, retentions for the light-curingresin are ground / milled.
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The bridge is safely fixed withthe polymerized prosthetic coping
Fabrication of the temporary restoration with visio.lign
Dr. Bayer, Landsberg
The remaining prosthetic copingsare integrated into the bridge using
light-curing composite
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The composite is polymerized.
Fabrication of the temporary restoration with visio.lign
Master dental technician Adler, Landsberg
The bridge is removed and completed
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The use of the visio.lign veneers allows
the fabrication of a temporaryrestoration within 3 hours without any
preliminary work
Fabrication of the temporary restoration with visio.lign
Dr. Bayer, Landsberg
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Success:Data from the Landsberg field study
58 completely documented individual cases
Observation period after completion
of treatment: at least 9 months
Total number of 312 implant restorations
No case of complete failure
Total of 4 implant losses
3 of these were terminal implants after
fracture of the temporary restoration
Date: December 2007
Extraction
Implant insertion
Immediate fixed bridge
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Advantages - dentist
Making optimal use of the local bone
Excellent load distribution for the restoration
thanks to posterior support
No investment costs for material / tools
High-quality temporary restoration
reduces work amount for the practice
No re-basing
Patient has time to select
his definitive restoration
Extraction
Implant insertion
Immediate fixed bridge
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Advantages
Good long-term prognosis since
augmentations that entail risks
can be avoided
Extended period until the
fabrication of the definitive restoration
All options for the definitive restoration
are available
Satisfied patients = increased publicity
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Advantage for the patient
Patient will leave the practice
with a fixed restoration
Palate-free restoration,
also for the temporary
No pressure spots caused by the temporary
No second (follow-up) surgery required
Clearly defined costs fixed price
Implant insertionExtraction Immediate fixed bridge
Oral situation upon entering
the practice 9 a.m.Patient upon leaving the practice
on the same day 3 p.m.
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Patient marketing
Solutions 10,000
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Thank you very much for your attention.