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Burzin Khan, Mumbai, India

Adaro Dental Laboratory Mumbai

SKY fast & fixed – temporary restoration

Introduction

Case description

Conclusion

After total extraction in the mandible, the foramen was located and the position of the

distal implants was planned above this. The midline was marked and, using the

angulation guide, the distal implants were placed at an angle of 35˚. The anterior

implants were placed equidistant from the midline in the lateral incisor region. This

provided an even distribution with a maximum spread to support the cantilever. After

the extractions in the maxilla, the position of the distal-most implants was marked in

the region of the second bicuspid and the angulation of the anterior wall was noted. It

may sometimes be necessary to make a small lateral opening to confirm this. The

trans socket cortical stabilisation gave good primary stability. The parameters of

immediate loading of the provisional were as follows:

1) Primary stability app. 45 Ncm²

2) Cross arch splinting within 24-48 hrs

3) No cantilevers

4) Occlusion to be well supported in the anterior segment from canine to canine

The SKY fast & fixed multi unit abutments were fixed with a torque of 25 Ncm². A

closed tray impression was made and the models were articulated using a silicone

bite and a trial wax-up of the arch was completed. An index of this set up was

prepared and the teeth were set in this index after melting away the wax. Acrylisation

of the provisional was made, engaging one titanium cylinder and using a silicone

sleeve on the remaining to provide space for the reline material. The under surface of

this prosthesis was made convex for maintenance and hygiene purposes. The

prosthesis was seated in the mouth and the other titanium cylinders were engaged

using Q resin and its activator. This ensured a passive fit of the prosthesis. The

provisional was polished and fitted into the mouth. The engaging screws were

torqued at 15 -18 Ncm² and the access screw opening was sealed using fermit

temporary resin.

This case describes a 61 year old female patient with multiple missing teeth and

mobile upper and lower front teeth. She was unable to chew with an existing

removable partial denture in the mouth. She wanted a fixed replacement but did not

want to be without teeth in the interim period.

The clinical examination and radiological investigations revealed chronic generalized

periodontitis. Pneumatisation of the sinuses was also present, but the patient did not

wish for grafting to be performed. It was decided that total extraction should be

performed along with full mouth reconstruction with extraction, immediate implant

placement and a provisional prosthesis, using the SKY fast & fixed technique.

The SKY fast & fixed therapy provides a good treatment option for a resorbed ridge

as it provides immediate function and aesthetics restoration. It is a graftless option

and hence saves time and many surgical procedures. Long tilted distal implants

provide a good spread and a stable support for immediate loading with transcortical

fixation. However the protocols must be strictly followed. The patient has been very

satisfied with the treatment and has readily accepted the limitations in function, as the

aesthetic result of the temporary restoration has already shown a significant

improvement.