Hello welcome to the DIO webinar
I'm professor Byung-ho Choi
at Yonsei University in Korea
Today you will be watching live surgery
which is about full-arch restoration
First, Let me introduce the patient
for the live surgery
She had many teeth problems in the mouth
First is, she wanted to get lower teeth problems fixed
Look at the remaining teeth
It had severe periodontitis
We decided to remove all the remaining teeth
in the mandible
She wanted to get a fixed prosthesis using implants
rather than an overdenture
And then we decided to do
All-on-six implant treatment
look at the remaining teeth
You can see here
some bone loss around his remaining teeth
To do implant planning
We put intra-oral markers on the alveolar crest
We took intraoral scan images
and CBCT scans
We merged two digital images
On the merged image
We did all-on-six implant planning
It was possible to position all 6 implants in the mandible
without bone grafting
We decided to cut the bone at this level
The treatment plan we established was
all-on-six implant placement
bone reduction
And immediate restoration
On the merged image,
we designed a bone reduction guide
A top part and a foundation part
This shows the foundation part
You can cut the bone using the foundation part
This shows the cutting level of the bone reduction
This shows a surgical guide design
which is connected to the foundation part
3D printed top part and printed foundation part
Printed surgical guide part
We prepared a provisional denture
to do immediate restoration
We fabricate it using a 3d printer
we also prepared
titanium temporary cylinders and rubber dam sheets
Now
We are ready to perform all-on-6 implant placement
bone reduction and immediate restoration
Let's move on to
live surgery
We performed surgery under general anesthesia
Because the patient was afraid of the operation
Another reason was
Severe bleeding.
It could occur during bone reduction
It's easier to control the bleeding
under the general anesthesia
First, the mandible is exposed
on the labial side
and this is the bone reduction guide
The bone reduction guide is placed in the mouth
This is an anchor drill
With a low-speed drilling
without irrigation
This anchor screw is placed
to fix the foundation part
You can see here low-speed drilling without irrigation
The speed is 100 rpm
The second anchor screw to fix the foundation part
The top part is removed by pulling it out
My left index finger is located on the lingual side
to get a sense of the sawing
to protect the lingual mucosa
And the bone segment is removed
The surgical guide part is
Now connected to the foundation part
of the bone reduction guide
Another anchor drilling for anchor screw
To fix the surgical guide part
The drilling is also low-speed drilling without irrigation
In between
saline irrigation is done into the osteotomy site
This anchor screw is to fix the surgical guide part
Another anchor screw to fix the surgical guide part
Irrigation is done
to remove the debris and to cool the site
Two anchor screws are used to fix the foundation part
another two anchor screws are used to fix
the surgical guide part
This is the first drill,
which is 2.0mm in diameter and 5mm in length
The drill uses a guide tube
The drill speed is also 100 rpm
In between the osteotomy site, it is irrigated
To remove bone debris and cool the site
The first drill is the most important one to drill
because if there is an error in the first one
There would be errors in the rest of them
Therefore you should be careful to drill the first drill precisely
The drill tube Is tied up with a thread
to prevent dropping it down the patient's throat
You can see here
prior to rotating,
I tried to get a sense of direction
After getting a sense of direction I started drilling
The first drill is very important
If the drill axis is created inside the bone
It is very difficult to be changed or to be corrected
The next drill is 2.7mm in diameter and 5mm in length
The drilling is a low speed
with 100 rpm
Now we are increasing the diameter of the drill
and the length of the drills
We are increasing the drill length and diameter gradually
This is a bone profile drill,
you can control the depth of drill using the marker
The implant is placed with a speed of 30 rpm
With a torque of 30Ncm
Once it is fixed with a 30Ncm torque
I increase the torque
I got a sense of initial strong stability of the implant
I also got a strong initial implant stability
of the second implant
The third implants in the molar area
I got a severe torque
You see here
Placing the implant with a ratchet.
I got a severe torque
The severe torque was released
by counter-rotating the implant connector
I got difficulty in removing the implant connector
I used this crown remover to take it out
And then we moved to the other side of the mandible
to drill and place implants
the drilling on the other side is being done
Using the same drill sequence as on the previous side
I got strong initial implant stability
of this implant as well
This implant as well,
I got a strong initial implant stability
All six implants had strong initial stability
which is about higher than 40Ncm
After placing the implant anchor screws are removed
All implants were placed
precisely within the alveolus
And then
straight abutments are connected to the implants
After connecting the abutment I check out whether
the abutment cuff height is appropriate or not
If it is not
You can change it
Whenever I connected the abutment
I checked the level of the abutment
the shoulder of the abutment should be
above the mucosa level
The abutments are tightened up to 30Ncm
All abutments are fixed
with a torque over 30Ncm
And then the temporary cylinders
are connected to the abutments
The cylinders are slightly tightened by a hand
After suturing,
rubber dam sheets are placed beneath the cylinders
And then the provisional denture is placed in the mouth
And check out whether the denture is placed in the right position
By checking the occlusion with the opposite teeth
Acrylic resin is injected around the cylinders
in the canine areas on both sides
And then the light-curing resin is polymerized
while ensuring the occlusal relationship
with the opposite teeth
After bonding cylinders in the canine areas
the cylinders in other areas are bonded
After polymerizing the resin
the provisional denture is removed
by unscrewing the screws
And I checked out whether the cylinders are
secured in place
the patient was taken to the recovery room
after the operation
And then we start the laboratory work
Converting the provisional denture
to the provisional fixed bridge
We started the operation in the morning
In the afternoon
when the patient was fully recovered
from the general anesthesia
We placed the provisional fixed bridge
in the patient's mouth
You can see here the provisional prosthesis
immediately after the placement
And we scanned the provisional prosthesis
You can get this in intra-oral image
by scanning the provisional prosthesis,
the opposite teeth,
the edentulous ridge
and bite scan
Using the image
You can design the next one
After taking this intra-oral image
the patient was discharged from the hospital
We started designing the second provisional prosthesis
The patient wanted to get a long crown, long teeth
Therefore we fabricated
the second provisional prosthesis
having long teeth
by milling PMMA blocks
One week later, one week after the operation
We removed the sutures
and placed the second provisional prosthesis
in the patient's mouth
This is the second provisional prosthesis
placed in the patient's mouth
Six implants were placed as planned
Look at here before and one week after the operation
She was happy with the prosthesis
Three months later
we are going to make a final prosthesis for the patient
Thank you very much for your attention
I hope you enjoyed today's live surgery
See you, I hope we will meet again soon.
Thank you very much, bye-bye
