Cain Zimmer® Revitali ze™ patient solutions 9/9/13

Immediate Provisionalization and Restoration of the Fully

Edentulous Arch Using Zimmer® RevitaliZe™ Patient Solutions

Presented by Dr Robert Cain and Debra Hall-Fisher, RDH

Sponsored by Dr Robert CainAnd Zimmer Dental, Inc.

Conventional Implant Therapy

• For Dentate Patients– Fabricate immediate denture– Extract remaining teeth, bone graft, seat denture– Heal for 3 – 4 months– Place implants, cover with tissue, wear denture– Heal 4 – 6 months– Uncover, place healing abutments– Fabricate final prosthesis

Conventional Implant Therapy

• For Edentulous Patients– Possibly augment bone prior to implant placement– Place implants, cover with tissue, continue to

wear denture– Heal 4 – 6 months– Uncover, place healing abutments– Fabricate final prosthesis

Treatment Rationale

Why?Patients that are fully edentulous may benefit from

Immediate Loading of a prosthesis often it can eliminate the need for a second

surgery Usually reduces the number of post-op visits for

Prosthetic maintenanceIncreases the patient’s overall comfortProvides immediate restoration of dental functionOffers immediately improved aesthetics

Treatment Rationale

• When?When a patient has mostly hopeless teeth – it

can sometimes be more costly in the long term to try to repair and maintain severely deteriorated dentition than to replace a full arch with implants and an implant-retained denture.

Treatment Rationale

• When?A patient has adequate bone - minimum of 10 mm

used to be considered mandatory – but not absolutely necessary with tilting implants

A patient has adequate bone width – at least 6 mm wide to accommodate a small diameter implant – but today osteotome techniques and bone grafting makes more options possible

You want to offer a solution that can be a complete “game – changer” for a patient

Pre-Treatment Diagnostics

• Overall health Screening- resulting in good health rating

• Diagnostic radiographs• Vertical dimension records• Articulated casts• Measurement of Gingival thickness• Verified Wax try-in

Pre-op phase

• Patient Sharon• Med Hx: throat

cancer with radiation, severe xerostomia, rampant caries

• Previous mandibular extractions, 2 implant Locator overdenture

Pre-op Phase

Cone Beam CT Scan SimPlant Implant Planning

Pre-op Phase

Fabricate Guided Surgery Guide

Pre-op Phase

• Fabricate Immediate Maxillary Denture• Prosthetics performed by Dr. Pamela Cain

and Ozzie Ritchie from Scrimpshire Lab

Surgical Phase

Anesthesia

Surgical Phase

Extract Remaining Teeth Contour Edentulous Ridge

Surgical Phase

Surgical Guide Try-inFixate with Bone Screws for rigid fixation

Surgical Phase

Drill Guides for OsteotomiesDrill Guide Sleeves fit into Simplant Guide

Surgical Phase

Implants Placed Six implants placed

Surgical phase• Placing the Angled Tapered Abutments:• Floss threader is placed through the floss hole and the abutment is delivered to the mouth, aligning the cone to

the abutment to parallel the anterior sites. The abutment delivery tool is used to assist in placing and aligning the abutment.

• The 1.25mm Hex Driver is used to tighten the abutment retaining screw which is preassembled in the abutment.

• The 30° Angled Tapered Abutment is used in the posterior implant sites.

Surgical phase• Angled Tapered Abutments with Abutment Delivery Tools:• The abutment delivery tools can be used to aid in the

visualization of the alignment and position of the abutments.

Surgical phase• Torquing the Abutment Retaining Screws:• The Restorative Torque Wrench is used to torque the Angled Tapered

Abutment retaining screws. • The abutment retaining screws are torqued to 30Ncm. • The Abutment Delivery Tools are removed by unscrewing counterclockwise.

Surgical PhaseTissue Level Abutments angled and straight in place

Restorative Phase

• Surgeon Places the RevitaliZe abutments and sutures the tissue closed around them

Surgical phase

• Ready for Provisionalization:• The patient can be transferred from the surgical

operatory to the restorative office for the provisionalization of the patient’s denture.

Restorative phase

• Surgeon or Restorative Dentist places the Titanium Temporary copings

Restorative phase

• After all the titanium Cylinders are in place – mark their position on the denture

Restorative phase

• Drill holes for the Titanium Cylinders to go though passively

Restorative phase

• Reseat the denture and check the patient’s occlusion – making sure there is sufficient space around each cylinder to pick it up. The cylinders may have to be cut off to allow the patient to close.

Restorative Phase

• Cut and seat rubber dam to protect tissue under denture

Restorative phase

• Block out the Screw access holes with cotton pellets, wax or wooden cotton swab sticks

Restorative phase

• Intraoral Pick-up of Temporary Copings:• Syringe of methyl methacrylate material is used to pick up the

temporary copings into the denture. Place methyl methacrylate material around the temporary copings and fill in the holes of the denture

Restorative Phase

• Remove Denture and Fill Voids and Gaps: • Remove the cotton pellets and coping screws and remove the denture

from the mouth. The temporary copings will be picked up into the denture. Fill any voids or gaps with additional acrylic or ERA PickUp material.

Restorative Phase• Finish and Polish the Denture:• The Titanium Temporary Copings may be shortened with a separating

disk or bur to be flush with the denture base surface. Also- be sure to cut off any cantilever behind the distal most implants.

• Polish prosthesis using traditional techniques.

Restorative Phase

• Reseat the Denture:Coronal and Apical views of the polished denture.

• The denture is reseated back into the mouth and the Coping Screws tightened to 20Ncm using the Restorative Torque Wrench.

Restorative Phase

• Denture in Mouth:• Completed denture seated in the mouth, facial and

Occlusal view. Screw access holes are blocked out with a cotton pellet and filled with a composite resin.

Restorative Phase • Denture in mouth:• Completed denture seated in the mouth.

Same day Surgical and Restorative Procedure Completed:Happy patient same day following the competition of the restorative procedure.

• The patient has undergone surgery and the conversion of the existing denture to leave the same day with a fixed denture in place on the day of surgery.

Questions so far???

Components Overview

WithZimmer RevitaliZe

System

Don’t Forget!!!

Any questions?

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