Edentulous Mandible_ Part 2


So now what I'm going to do is I'm going to place my multi-unit abutment on the distal implant. And so I do that, I guess there's a little nuance to it. But I place it on the implant and then I see where that long, you see that long metal shank on it, how that lines up. And so I want that to be parallel to the, or as close to parallel as possible to that anterior implant. So I'll put my distal multi-unit on, then I'll put my anterior multi-unit on or like otherwise just evaluate how, like the angle of my anterior one. And if it's not very parallel, what I'm, what I can do is I can rotate that implant a little bit. So I'll go ahead and give that implant like a, like a quarter turn. So I'll rotate it one way or the other to try to get those, those multi-units to line up a little bit better. You can also place your multi-unit abutment on in different orientations and try to get it to match up too.

So what I always do is I try to get one distal side to match the anterior site. And then I'll, I'll work on the other distal site and try to get that to match the anterior. So that way it's just a little bit easier to keep track of everything. If you're trying to match up one distal site to the other distal site, it gets kind of complicated. So right now you can see that I have both of my multi-unit abutments on, and I'm just comparing them to each other. I'll look from the front, I'll look from my side, I'll look from the, I'll have my assistant look from the, from their side, and we're just trying to find the best orientation. It's okay if it's off a little bit. Right now it looks like it's off like, it's off less than 10 degrees. And that's just fine. So I can evaluate what I might need to change up.

So you can see that the anterior one is off just a little bit, and I'll try to correct that after I've placed, you know, after I'm a little bit closer to finishing. Your Minnesota dot's good, yeah, perfect. Maybe switch your Minnesota switch back to my right. Right here, please. Alright, so now I'm going to go to the other side and put my multi-unit abutment on too. So I'm going to go ahead and compare the angulation of that one to the one all the way in the front. What, I think all of them draw pretty well now. There is some divergence, so what you can do, and I think what I ended up doing for this case, just because I was nitpicking about it, you can actually change that anterior multi-unit to a 17 degree, because right now it's a straight. So a 17 degree abutment might be able to, you know, get that angle even a little bit more spot on, but right now all of them look fairly parallel enough. So what I do now is I just place some sutures. I'm using non-resorbable, I'm using PTFE, and just doing some interrupted sutures in between all the implant sites, and then I close it up, and I'm going to put some healing caps on each multi-unit. If you do want to go ahead and move on to conversion after this, what you would do is you would index the denture at this point, and that's something that I show you how to do in the conversion videos. So you index the denture, and you relieve it, and you start your conversion accordingly. I need a tissue for it. You can pull back here. I would never have a teeth on it, is that okay? Melissa, you should get in touch with your family from Hawaii. Tell them we're coming. They cry when we leave. It's okay, it's another reason. What I want, I want a Mai Tai near the beach. With some poi. Oh, I don't like that. You don't like the poi? I like Spam Musubi. Oh yeah, Spam Musubi's my favorite. It's a little out of your vision, huh? Yeah, not a lot though. It's like I can eat it, but not like all of it. What's up? I need one more hand. You can't just grow one? No. I think I'll be the first in line whenever I grow a hand. Did I tell you that guy that came to the office, he's from the company Yomi? They sell robots that place implants. Oh yeah, hey, did that person come? Yeah. When I left. How was it? Was it cool, or? Super cool. Too expensive though. It like places them for you? Yeah, you have to hold the hand piece though. It still places them basically. What about like a robot robot where he's standing over the patient placing implants? Oh, it is a robot. Yeah, it's way expensive though, so like, not for me, but I can see how like a center, like a big center would - Would use it? Yeah. Is that for your choice? I feel like the tip's already done. You gotta put that, the little - T -trigger? Yeah. I like that. See if you can put some first. Do you want another one, doc? Because I have one more. Awil, can you open this one for me, please? I'll get out of your way.

You say RT? R -R -feet. R -feet, yeah, yeah, yeah. With the feet. Hope this 360 camera works.

Yeah, we got a 17? 17 abutment? Yeah. Can you bar it open? I'm just gonna put one more back here, one more. Ahem, ahem, ahem, ahem.

You okay, Hamid? You're so talkative today. You need that driver? This is the 15? This is the 17? Yeah.

Alright, so remember earlier I was telling you that I wanted to get that front one to align a little bit better. Remember, it was a little bit off, off axis. So what I did now is I'm, well, what I'm doing right now is I'm changing that multi -unit, that straight multi -unit, for a 17 -degree multi -unit. And so when I put the 17 -degree on there, I'm going to be looking from both sides and seeing how I can get it to match up with the posterior implants, and I might even need to rotate the implants. So I spent a good amount of time doing this just to get everything to line up a little bit better.

Okay, you have the most zoomed out perspective. Okay, I'm just going to show you this. See how this middle one's a little off angle? You're going for the right. Yeah, maybe like 15 degrees. So I'll switch it out.

That's not as, is it the same spot you had as before? From here it's off. I'm going to look from your side. Honey, can you turn towards me? From straight forward it looks pretty good. From straight it looks good? From straight it looks kind of the same as your straight though. Yeah. Oh, does it?

I'm just nitpicking. If you rotate it to the left maybe. I'm going to put my big hand on there. From this side it looks really good. From this side it looks good, but from your angle it's a little off. I see what you're saying. Yeah. Turn this way? Yeah. So back it a little bit. Yeah, but that's okay. Yeah. Still better than it was originally, right? I think so. Okay, I'm going to screw it down.

Hon did say the healing abutments are supposed to come in. Oh, that's okay. We'll just leave it like this too. Yeah, I will. But I just want to make sure that what our angles work. Can you chin up a little bit? You got it open? Can you turn a little bit that way? This one's like five degrees off this way. Does it matter? Yep.

I'm just going to tighten it a bit. I'm going to take these off. It's run around soon. What did I say? I think you said run around quick. Oh yeah, I almost said. Yeah. You're a fast worker, man.

All right, so now that I have all of the multi -unit abutments kind of as good as I feel like they're going to get, I'm going to go ahead and torque each abutment. I don't do this beforehand because if you do this before and you decide you want to change your abutment position, it's going to be really hard to remove that abutment. And you might even disrupt the implant itself. You might accidentally back out the implant when you're trying to take off the abutment. So I only torque it down after I'm happy with all my abutment positionings. And I'm going to go ahead and take all these down to a 20 newton centimeter torque.

He did stop, but he's still bleeding? No, just a little bit. I think because I keep touching it. And I need his denture and I need a little bit of the alginate just so I can hollow out the denture so it doesn't put pressure. Only reason I'm not torquing the front one right now all the way, I torqued it to 15, is because I want to make sure that that's the right multi -unit. I want to keep on there permanently. So I just put it on 15.

It's still relatively easy to take them off. But if you torque them all the way, then it gets hard to take them off sometimes. Alright, we're good. So it's all torqued. Perfect. You okay? I'm just going to adjust your denture now, okay?

And now we start the conversion. Thank you. You can go ahead and close down like you normally would. Perfect, right there. And just hold it right there for a second. Not too much pressure, okay? Yeah, so that way it doesn't come up and cover your abutments. Yeah, and then it attaches to the bottom of the bed too.

Alright, so right now I'm going to show you what I would do if I'm not immediately loading them. I'm going to actually have to clear out a little bit of space in the denture. So that the denture is not bumping the implants and applying pressure. So I use some bite registration material inside of the denture. And then I seed it. And then I just let it set up. And after it sets up, I'm going to pull it out and adjust the areas where I see that there's show -through. So in some little areas of the denture, you're going to see some show -through. And that's what you use to adjust with the acrylic burr.

So now you're seeing me going ahead and placing the healing caps on each multi-unit site. So you should actually do this before you do the... Before you place the bite registration and index where the implants are. Because you're going to see what happens at the end of this video. I ran into a little complication where I got some... I got some bite registration stuck inside of the multi-unit abutment screw holes. So definitely place the healing caps on each multi-unit abutment first. And then you're going to place the bite registration inside the denture. And index where those implant sites are.

Yeah, that's really nice. What? They're only finger-tight, K-Duck. Well, now I got to remove more. Yeah.

Hey Alvin, are we doing a re-run as well? Not today. I feel like it goes and then it doesn't. So usually you want to see it at first. Yeah, exactly. Like move it around. And then if you can't find it there, hold on to the healing abutment and then use the screw. Need me to help you out? Yeah, I think it's this last one. Oh, that's right. Yeah, no, you kind of want to like move it around a little bit. Put it there and try a couple different... Yeah, you got it? Yeah, I don't know. Let's try a couple different little orientations. A screw suction right in there? Might be something in there. Right in the middle. Yeah, there's a... There's a... What do you call it? Alginate. Alginate, yep. You want me to get another wire? Yep.

Alright, so right now at this moment I realized that I can't seat my healing cap on there because there's some bioregistration stuck inside the screw access hole. So that happened because I should have actually... I should have done the indexing of the implants after I placed the healing caps on. So that way when I put the bioregistration, it doesn't get stuck inside the access hole. So now I have to go in and try to pluck this thing out or push it out of the way really, really carefully so I don't damage the internal threads of the multi-unit abutment. But anyway, once I get this guy out, I'm going to place the healing cap on and then the denture just gets placed over the top. If you want to be extra safe, what you can do is put a little bit of more bite registration inside the denture, seat it one more time, just recheck if it's binding anywhere and then relieve it accordingly. You definitely don't want any pressure at these implant sites during the osseointegration period if you're not going to be converting it on the same day. So if you convert it on the same day, all of your implants are splinted together and there's a kind of a uniform pressure. But if you're not immediately loading it and you do have an uneven load on them, I feel like it could lead to failure. So that's why I leave this not touching my denture. Thank you.

Lesson Summary

The process of placing multi-unit abutments on implants and aligning them parallel to each other is described in the text. The author mentions adjusting the abutments and evaluating the angles in order to ensure proper placement.

Non-resorbable sutures and PTFE are used for interrupted sutures between the implant sites, as mentioned by the author.

The placement of healing caps on each multi-unit abutment is also discussed, along with the use of bite registration material in the denture to create space for the implants.

There is a brief mention of a conversation about robotic implant placement and unrelated personal conversations.

The author concludes by mentioning the need to torque the abutments and begin the conversion process.

In a dental procedure involving the placement of a healing cap on an implant, the speaker realizes that there is bioregistration material stuck inside the screw access hole, preventing proper seating of the healing cap.

The speaker explains that this issue occurred because the implants were not indexed after placing the healing caps. They outline their plan to carefully remove the bioregistration material without damaging the abutment threads.

Once the bioregistration material is removed, the healing cap and denture can be properly placed over it. The speaker suggests adding more bite registration inside the denture to ensure that it doesn't apply pressure on the implants during the healing period.

The text highlights the importance of relieving any pressure on the implant sites during the osseointegration period to prevent failure.

The use of a robot-assisted implant placement system is mentioned, along with the need to align the multi-unit abutments for better outcomes.

Finally, the author concludes by mentioning the process of indexing the denture and adjusting it before considering immediate loading.

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