Implant Placement and Immediate Final Rehabilitation

After taking the final impression, a master cast was created (Figs. 19 and 20) and the previously set-up den- ture was adjusted to fit this cast (Fig. 21). A silicone putty matrix covering over the teeth of the set-up and down to the model base was made. When cured this was removed and the set-up was removed from the master cast. A mixture of acrylic resin with barium sul- phate was then poured into the portion of the matrix containing the teeth. This reproduced the arch of teeth and would be the radio-opaque foundation of the diagnostic stent used for the CT survey. After taking care to block out the ball attachments of the tempo- rary implants the space between the radiopaque arch and the master model was filled in with transparent acrylic (Figs. 22 and 23). The process of fabricating the CT diagnostic stent was completed by incorporating a radiopaque toy brick as a baseline reference unit for orientation within the implant3D planning software. Safety markers provide additional verification (Figs. 24 and 25). For precise transfer of the positions of the temporary implants to the CT diagnostic stent, the housings of the ball attachments were secured in place right in the patient’s mouth with self-curing resin (Figs. 26 to 29). Finally, an orthopantomograph was obtained to verify that the housings were correct- ly seated on the ball attachments (Fig. 30). EDI Case Studies 8 Fig. 20 Master cast with laboratory analogues of the temporary implants (ball attachments). Fig. 19 Impression copings placed on the temporary implants. Fig. 23 CT diagnostic stent. Fig. 22 Silicone bite rim with the radiopaque dental arch. Fig. 21 Master cast with the mandibular arch set-up. Note the recesses to accommodate the ball attachments.