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

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  • Place floss in the hole in the Abutment Delivery Tool. This procedure is essential for safety purposes to prevent swallowing or inhaling the component.
  • The angled abutment is taken to the mouth and proper orientation is made. It should have an orientation that will allow screw access that will be parallel to the straight anterior implants. Note, the clinician may select a position that is best suited to the case. When the proper orientation is selected the Hex Driver is used to tighten the internal screw. The Hex Driver position will be parallel to the implant angle.
  • When the process of placing and tightening the abutment is complete the Abutment Delivery Tool is removed.
  • Place tapered abutments on the two anterior implants using the Hex Driver.
  • The included maxillary denture will represent a denture the patient is wearing or an immediate denture that has been made for delivery at the time of surgery. The position of the implant abutments is located and marked in the denture. Holes are then drilled in the denture to allow the Titanium Temporary Copings to extend into for picking them up in the denture conversion process. A clear duplicate denture is included to demonstrate this process.
  • Place the Titanium Temporary Copings on the abutments. When the 4 are in place they should be parallel.
  • Clear denture showing holes in correct position to allow space for the Temporary Titanium Copings.
  • The provisional and final prosthesis should be convex on the tissue surface area. In the maxillary ridge area it should lightly touch the tissue. It should NOT lap over the ridge.
  • The mandibular model has 5 straight implants. The model will be used to demonstrate the placement of Tapered Abutments, place indirect transfers (ACTIT) and make an impression.
  • The Hex Driver will fit into the Tapered Abutments.
  • Place abutments and tighten
  • Indirect Transfers (ACTIT) fit onto the Tapered Abutments. Lightly tighten the transfers but DO NOT over tighten these transfers.
  • After the impression, Tapered Abutment Replicas (ACTR) will be attached to the indirect transfers and the transfer is reseated in the impression.
  • Do not over tighten the transfers
  • Impression material is carefully placed around the transfers to get a good impression of the soft tissue and transfers. It is also important to get a good impression of the edentulous ridge.
  • Attach transfers to replicas and insert transfer back into impression.
  • A working cast can now be poured from the impression.

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

  • 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 Cain And 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 maintenance Increases the patient’s overall comfort Provides immediate restoration of dental function Offers 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, rampan t 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-in Fixate with Bone Screws for rigid fixation
  • Surgical Phase Drill Guides for Osteotomies Drill 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 Phase Tissue 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 With Zimmer RevitaliZe System
  • Don’t Forget!!!
  • Any questions? Thank you for attending