The Immediate Provisional Hybrid

[Anonymous]

CASE REPORT
Immediate Provisional Hybrid Technique:
For our patient, the treatment process began by making a denture: the same type that is typically created when teeth are extracted or existing dentures are replaced. This is to be converted into a temporary hybrid denture at the time of implant surgery. The surgeon then placed dental implants, installed temporary abutments (Figure 2), and the extraction sites were sutured to close the tissues.

Next, the restoring dentist modified the new denture to fit over the temporary abutments (Figure 3a). Although there is a short learning curve associated with this step, it becomes very easy after completing a few cases. This step can be completed ahead of time if the implants are placed with an implant placement system such as NobelGuide (Nobel Biocare). A presurgical working model was made using a surgical template, and the holes were predrilled prior to the day of surgery (Figures 3b and 3c).

After the denture was properly fitted over the temporary abutments (Figure 4), the denture was processed in the mouth to the abutments. First, the access holes were plugged with plastic Q-tip rods to prevent acrylic from closing off the opening to the abutment screw. Then, the denture was processed to the abutments using fast-set denture repair acrylic. This was done by placing the uncured acrylic in a plastic syringe and expressing it into the opening in the denture next to the abutments (Figure 5). The denture was held firmly in place until the acrylic cured completely. After it was cured, the Q-tip plugs were removed and the denture was converted into an implant-supported hybrid denture. All excess acrylic, and most of the denture flange, was removed to make a high-water-type appliance. After adjusting the appliance, the underside was polished and glazed for a smooth finish that would facilitate proper hygiene (Figure 6).

The hybrid was then attached back to the implants. The screws were torqued to 35 Ncm, then the access holes were filled with cotton and Cavit (3M ESPE).

The patient left the day of surgery with a fixed-hybrid denture (Figure 7) that served him for 3 to 4 months while the implants completely integrated.

During this time, we addressed any issues of occlusion and function. The patient was restricted to only fork-mashed food for the first 3 months, after which he was able to resume eating normal food.

The final restorations were delivered at 4 months post surgery, and the patient was extremely pleased with the final outcome (Figure 8).