TRANSCRIPT:

Okay, so after you got your abutments seated, let's go ahead and take off all of these temporary cylinders. Take all these guys off. Careful with the screws. Don't lose them. Let's take all these guys off. Alright, if you are a hundred percent happy with your abutments, go ahead and hand tighten them as much as you can. If your implants got an engagement of 30 Newton centimeters or higher, go ahead and get your torque wrench and torque these guys down. I would just take it to 20. Just take them to 20 for now.

Torque all of these guys down because if you don't do it now and something changes between now and the time you load your conversion prosthesis, or if you give the patient the conversion prosthesis, you let them go home, these guys can start to come loose. So I'll go ahead and torque them to 20 Newton centimeters if you can.

Now, the only trouble is if you torque it and it was not a very well engaged implant, it's gonna rotate your whole implant so if your implant does rotate, just get your torque wrench, put it on reverse and rotate it back a little bit and it should rotate back to where it was. Be very careful with it. You've been warned.

So once you've torqued those guys down, I like to put little healing caps on. So I'm gonna put healing caps on all of my abutments. Just use very light finger pressure. You're not trying, you're not going for tightness here. You're not trying to get them super tight because what ends up happening sometimes is you can actually pull out the abutment when you're trying to unscrew these healing caps later. So another reason why you want your abutments torqued if you can.

So healing caps are all placed. Surgery is done. Well, actually now you have to suture. So what I like to do is put some interrupted sutures so one interrupted here, interrupted here, here, here, and here. So I'll tack it down. I'm not gonna spend 45 minutes suturing right now. All I'm gonna do is put an interrupted here, here, here, here, and here. And the reason I'm gonna do that is because after that, I'm gonna start my conversion process. But just to show you, I'm just gonna put this little Surgical guide over my implants, and I'll just show you where the access holes ended up being. So it looks okay. If I were to have had a 30 degree back here, I would have corrected it even better and it wouldn't be like so buckle, you know, but hey, showing you how to make lemonade, right?

So, all right, let's go ahead and get our denture. And at this point, what I'm gonna do is I'm gonna index where my implants are relative to the denture. Alright, one second, so I want to start preparing for my conversion. And so what I'm gonna do is I'm gonna get some bite registration material. I didn't bleed it. It's coming out different colors. Anyway, I'm gonna get my bite registration material. Put it inside the denture. And my first goal is to make sure that this denture seats and it seats uninhibited, right? So I'm gonna put it right there. And I'm just gonna let it set up for a second.

I'm just gonna let it sit there. Just give me just a second, and we'll I'll pull it out, and then I'll show you what to do next. Alright, so before you took the impression, actually the best thing to do is to put some Vaseline over the sutures so that way you don't accidentally rip out the sutures with this bite registration material.

So now let's pop this guy off, and so now you can see where your implants are in relation to the denture, and so what you can do is while I'm suturing this up a little bit tighter, what I have my assistant do is just go with a football burr and hollow this out. Hollow this out. So that way it's not touching any of the implant sites. Just to, I guess, step back just a little bit, what you can do is just make sure that it's not touching any of these cylinders so you can just stick this football burr in there, swirl it around, make sure it's not touching any of the cylinders or any of the healing abutments, and then go back and try it on again and make sure that your denture is seating the way that you want it to seat.

So I'm gonna go ahead and just adjust the inside of this denture so that it's not touching any of these healing abutments. Alright, so I've adjusted the underside of this denture and this bite registration material. And you can see that I went all the way through until I came out the other side. But I did not widen this top part yet. I just barely made it so that it's not going to be interfering so that these healing caps are not going to be interfering with the positioning of the denture.

So now I'm gonna put the denture back on the patient, and I'm gonna make sure that this denture seats fully seated, that the midline is on, and that this is fully seated. And what I'm gonna do is I'm gonna have the patient go ahead and bite down, or I'm gonna make them bite down, right, and I'm just gonna double-check. So the patient's missing some upper teeth. So I'm gonna double-check that the occlusion is right where I want it to be. If the occlusion is not where I want it to be, then that means that there might be some interference inside here still, and so if there is, go ahead and adjust it more.

Lesson Summary

1. After seating the abutments, remove all temporary cylinders and be careful not to lose the screws.
2. If you are satisfied with the abutment selection, hand tighten them as much as possible. If the implants have an engagement of 30 Newton centimeters or higher, use a torque wrench to tighten them to 20 Newton centimeters.
3. To prevent the abutments from coming loose, torque them down securely.
4. Place healing caps on all the abutments using light finger pressure.
5. Suture the area using interrupted sutures.
6. Position a surgical guide over the implants to determine the location of the access holes.
7. Prepare for the conversion process by using bite registration material inside the denture to index the implant locations.
8. Apply Vaseline over the sutures to prevent them from being ripped out by the bite registration material.
9. Remove the denture and use a football burr to hollow out the areas around the implants, making sure they do not touch the cylinders or healing abutments.
10. Adjust the inside of the denture to ensure it does not touch the healing abutments.
11. Replace the denture on the patient, ensuring it is fully seated and the occlusion is correct.
12. Make any necessary adjustments to the denture if there is interference with the healing abutments.