Aims

To present an overview of the full mouth immediate loading protocol.

Objectives

This masterclass aims to explore the indications for this procedure, steps involved prior to surgery along with the close teamwork required on the day of surgery. The importance of a close involvement of the technical team and the technical stages of provisional and final prosthesis delivery will be explored.

This class will also look at the management of complications, the maintenance requirements and success rates of the full mouth immediate loading protocol.

Patient selection

What patients are suitable and not suitable for this protocol?

Advantages of this protocol

- Reduced treatment times
- Ready patient acceptance
- Avoidance of grafting
- Predictable aesthetics
- Reduced cost

Disadvantages of and alternatives to this protocol

Planning

- Pre- surgery prosthetic planning stages for a partially edentulous patient
- Pre-surgery prosthetic planning stages for a fully edentulous patient
- Radiographic planning stages
- Particular points:

• Smile line
• The relevance of an opposing natural dentition
• Planned occlusal scheme
• Space

Consent

Specific consent issues related to immediate function on dental implants; both surgical and prosthodontic consent issues.

Templates

Surgical templates from simple to complex

Surgery

- Surgical technique for the partially edentulous patient:

• Flap design
• Management of the alveolar bone and recent extraction sockets
• Implant sites
• The principles of using tilted, splinted implants
• Required implant design
• Required insertion torques
• Suturing:

- Surgical technique for the fully edentulous patient:

• Flap design
• Suturing

- Common surgical complications and how they are managed
- Chair side pick-up of the implant positions in the provisional prosthesis
- What information is needed for the technician?

Fitting of the provisional restoration

- Specific patient instructions
- Length of time for which the provisionals are worn
- Monitoring of the dental implants
- Hygiene protocol
- Common early implant and prosthodontic problems and how they are managed

Evidence

- A summary of the relevant literature relating to survival and success rates of the implants
- A summary of the relevant literature relating to the prosthodontic complications

Technical aspects

- Working with your technical team in the planning stages
- A run-down of the work flow for the partially edentulous patient who will need planned extractions
- A run-down of the work flow for the patient who is edentulous
- Working with your technical team with regards to smile line and the finish line of the prosthesis and the proposed aesthetic outcome
- What the technician needs to do on the day of surgery
- What information do the clinicians need to give the technical team on the day of surgery?
- What are the common mistakes?
- Checks that need to be done once the provisional prosthesis is delivered
- Stages involved in the construction of the definitive prosthesis
- Material choice