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Video Details
Immediate Reconstruction of the Posterior Mandible with Multiple Implants

Description:
This surgical video highlights the diagnostic phase with review of the CBCT and 3D images to properly treatment plan the placement of multiple adjacent implants for immediate temporization in a previously grafted mandibular posterior region. Anatomy of available bone and location of the mandibular nerve are discussed. Implant placement and confirmation of accuracy of the plan utilizing restorative and surgical guides are described. Bone grafting using allograft mineralized bone and PRGF as well as management of the gingival tissues as part of effecient surgical protocols are clarified. One Abutment-One Time techniques are instrumental in facilitating immediate temporization utilizing the placement of final abutments at the time of implant insertion. The Restorative phase is described highlighting the the use of acrylic copings for these abutments, immediate reline at the time of surgery using a vacuum formed matrix and Triad reline material. 2 month post-op images of healing of soft tissues and final impression taking utilizing snap caps and flowable resin are also included.

Date Added:
6/5/2013

Author(s):

Maurice Salama, DMD Maurice Salama, DMD
Dr. Maurice A. Salama completed his undergraduate studies at the State University of New York at Binghamton in 1985, where he received his BS in Biology. Dr. Salama r...
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Online Videos / Surgery / Implant / Immediate Reconstruction of the Posterior Mandible with Multiple Implants




Questions & Comments
Rene Rebeil - (6/9/2013 6:04 PM)

Exellent presentation as well as the spanish translation

henry salama - (6/8/2013 12:08 PM)

For most clinicians, hand tightening the abutment fully at the time of placement will probably deliver in the range of 15-20 Ncm and that is enough to seat the abutment completely. The so called "pre-torque" that we perform when we do final torquing to 30-35 Ncm creates an effect on the SCREW not on the abutment position. Therefore, no adverse positional change or affect should be seen on the final restoration. Hand tightening at placement ensures easy removal & replacement of the primary abutment in case it is deemed as not optimal for a final restoration. I hope that helps.

Paul Boulos - (6/8/2013 7:17 AM)

Dr Salama.thanks for the nice presentation. my question is if you torque the abutments before cementation this might affect the seating of the crowns especially if they are joint. meaning that the abutment might sink a bit into the fixture and its all varied on the three fixtures.any comment. thank again for the beautiful work.

henry salama - (6/7/2013 2:47 PM)

At implant placement, restorative abutments are only hand tightened. Final torque is not utilized until the abutments are deemed acceptable and only prior to final cementation. There are many ways to utilize the "one abutment/one time" technique. One, utilize pre-machine contoured abutments that have dedicated snap on components, or, choose and shape an abutment as needed and impress it prior to placement to fabricate a refractory die. That die is utilized by the lab to fabricate a resin transfer coping that can be used for taking the final impression.

e chan - (6/7/2013 11:48 AM)

Are the final abutments torque in at 30Ncm in 2 months on the day of final restoration cementation? So the final crown restorations are finished after 2 months healing? At surgical stage, you just put the final abutments on and do the temporization without torquing abutments, right? If one abutment one time and never removed, then do you just use snap caps and take impression and no need to remove the final abutments to give to the lab to adjust the final abutments, and leaving all final abutments in mouth after you put them on on the day of surgery.

rally garcia - (6/7/2013 3:37 AM)

awesome !!

Maurice Salama - (4/11/2013 3:22 AM)

Thanks Bassam. We are considering revisiting past cases and showing the follow up and reposting them. Would that be of interest? Dr. Salama

Bassam Algheryafi - (4/10/2013 7:58 PM)

Very inspirational presentation Dr.Salama; is there anyway you can put together all links related to this case or any case in future thus we can watch it from the start to finish? thanks for your dedication to this forum.

Maurice Salama - (3/27/2013 5:22 PM)

Loc; Thanks for the nice comments, please see my previous post below. Arrestin or Acromycin can be utilized for the antibiotic paste. Thanks Dr. Salama

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