Dr. Wolfgang Bolz, Munich/Germany, demonstrates the implantation and immediate fixation of dentures in the upper and lower jaw of an edentulous patient. The point of this surgery is that the posterior implants are inserted at an angle, which allows the insertion of longer implants and increases primary stability. Also, bone augmentation prior to the surgery is not needed. At the end, the implants are immediately loaded with fixed dentures.
The required high primary stability is achieved through a special bone preparation and the implantation at an angle. In the upper jaw, the posterior implants are inserted right next to the medial sinus wall, not straight into the alveolar bone but at an angle of 45 degrees, coming from the distal direction. In order to enhance primary stability in this region, the operator recommends and demonstrates undersized implant site preparation. After the implant insertion in the maxilla, on both sides a sinus lift is conducted with a mixture of autologous bone, bone substitute and blood of the patient. For prosthetic reasons the alveolar bone height is reduced.
In the anterior region of the mandible, a crestal incision is conducted followed by a medial vertical relieving incision to prepare a full flap on each side. The four last teeth, which are not worth preserving, are first kept to facilitate the prosthetic orientation. Only once the direction indicator is placed according to the position of the remaining teeth, they are extracted. Again the drilling for the implant beds in the premolar region is performed at an angle, in this case through the medial wall of the extracted premolar. A metal template is applied to give an orientation for the angulation of the posterior implant beds.
Once all implants are in place, an impression is taken with inserted implant posts to prepare the model in the dental laboratory. After the removal of the impression posts healing caps are applied, and an impression is taken with the prepared old dentures and a silicone material. About 2.5 hours later the implant supported dentures can be secured to the implants.