A Common Sense Approach to Full Arch Implants by Dr. Cory Glenn DDS Dentaltown Implantology

A Common Sense Approach to Full Arch Implants by Dr. Cory Glenn DDS Dentaltown Implantology https://bit.ly/1PQjoK7. Introduction: If you spend much time listening the fixed prosth gurus, you'll notice a common theme........they all start from the end goal and work backwards to get there as opposed to the "prep and pray" approach where you just prep the teeth, send it to the lab and hope for the best. Prep and pray is crazy IMO. And yet, many who do full arch implants do exactly that.............this is the "place and pray" approach. There's even more at stake in implantology because we're dealing with a surgical procedure. If you don't plan with the end in mind, there can be SOOOO many pitfalls.

I want to share this case as an example of how I do these implant rehabs with the end result in mind and work backwards to see how they can be restored and where the implants need to be to pull it off. The Blue Sky Software is phenomenal and is the only one I'm aware of that allows you to do all the things I'll show. And it's FREE

This patient presented fully edentulous after having all her teeth removed and desiring something other than removable. She didn't have a lot of bone in the maxilla and I didn't know how that bone corresponded to where "teeth" needed to be so how do we start? You gotta start with a treatment denture. Establish ideal esthetics, phonetics, VDO and bite with a removable denture FIRST!

Yes, I'm that guy who will set his own denture teeth when nailing it really counts......it's a process made really easy by the Kois Facial Analyzer and the Panadent Waxing table. Check out this thread if you're interested in more of those details. https://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=123&t=254765&r=3915725

So here's the wax try in. She was very pleased. So we processed these and let her wear them another 2 months while letting the bone mature since she was fresh off of her extractions.

Once the restorative position has been established, we need to do the proper imaging to do planning and guide fabrication. This starts by duplicating the treatment dentures in radiopaque acrylic, then relining them with PVS for the best possible fit, and placing radiographic markers on them (note the little glass beads). The patient then wears these for scanning.

Here's how the dups show up in the scan (this was Anaxdent 12.5% Barium Sulfate acrylic I used to duplicate). See the glass bead markers?

Do you see the little glass bead markers? These will allow stitching to an optical model of the denture cast.

This is a unique aspect I came up with for stitching these full arch cases. After the patient scan, I take that PVS relined duplicate and pour it up in stone and leave a generous land area. I also create little divots in the land area. I send this to my lab with instructions to give me an optical scan (STL) of the denture stil attached to the model which is what you see here. Then I have them separate it and give me a second STL of the cast which is just the tissue surface.

Note the 2 sets of "markers" The radiographic markers and then the land area divots

The CBCT is stitched to the denture model by means of the radiografhic markers

Now we have to stitch the tissue model to the denture model.......we'll use the common points on the land area (divots) to do this.

Here they are all stitched and everything is oriented properly to the CT surfaces too

Now I planned my implants based on where the bone was and where I needed them to emerge prosthetically

I could also turn off the denture and see their emergence through the tissue

Once you're happy with positions, it's simply a matter of designing the guide in the BSB software and exporting it for printing.

I'm a geek and have the Juell 3d printer in house so I printed all these guides. The total for the 4 guides on this build plate was about $3-4 of resin if I remember correctly

Alcohol soak and then UV cure

Here's the final guides. I did 1 for the upper and 2 for the lower.......I'll use the smaller drill first on bottom and then gauge the stability with a rotary osteotome. If I need to, I can go to full drill size with the other guide.

Conclusion: I continue to be amazed at how easy these cases can be when you PLAN PROPERLY. Knowing this protocol puts implant cases like this in the wheelhouse of any dentist with some basic implant experience and surgical skill.

I completed the upper arch yesterday under local anesthetic in about an hour while still doing hygiene checks. Even if you didn't have a 3d printer like I do, you could outsource this and the total cost in guides would be under $100 compared to thousands with other similar competitors.