1. 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.

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. Pre-op phase
• Patient Sharon
• Med Hx: throat
cancer with
radiation, severe
xerostomia, rampan
t caries
• Previous
mandibular
extractions, 2
implant Locator
overdenture

9. Pre-op Phase
Cone Beam CT Scan SimPlant Implant Planning

10. Pre-op Phase
Fabricate Guided Surgery
Guide

11. Pre-op Phase
• Fabricate Immediate Maxillary Denture
• Prosthetics performed by Dr. Pamela Cain
and Ozzie Ritchie from Scrimpshire Lab

12. Surgical Phase
Anesthesia

13. Surgical Phase
Extract Remaining Teeth Contour Edentulous Ridge

14. Surgical Phase
Surgical Guide Try-in
Fixate with Bone Screws for rigid
fixation

15. Surgical Phase
Drill Guides for Osteotomies
Drill Guide Sleeves fit into
Simplant Guide

16. Surgical Phase
Implants Placed Six implants placed

17. 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.

18. 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.

19. 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.

20. Surgical Phase
Tissue Level Abutments angled
and straight in place

21. Restorative Phase
• Surgeon Places the RevitaliZe abutments and
sutures the tissue closed around them

22. 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.

23. Restorative phase
• Surgeon or Restorative Dentist places the
Titanium Temporary copings

24. Restorative phase
• After all the titanium Cylinders are in place –
mark their position on the denture

25. Restorative phase
• Drill holes for the Titanium Cylinders to go
though passively

26. 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.

27. Restorative Phase
• Cut and seat rubber dam to protect tissue
under denture

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

29. 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

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. Questions so far???

36. Components Overview
With
Zimmer RevitaliZe
System

47. Don’t Forget!!!

61. Any questions?
Thank you for attending