The Immediate Provisional Hybrid

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IMMEDIATE PROVISIONAL HYBRID

The treatment process begins with making a denture, of the same type that is typically created when teeth are extracted or existing dentures are replaced. This is converted into a temporary hybrid denture at the time of implant surgery. The surgeon then places dental implants and installs temporary abutments (Figure 2). The extraction site is sutured to close the gum tissue.

At this time, the restoring dentist modifies 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 the NobelGuide procedure by Nobel Biocare. A presurgical working model is made using a surgical template and the holes are predrilled prior to the day of surgery (figure 3b, 3c).

After the denture is properly fitted over the temporary abutments (Figure 4) the denture can be processed in the mouth to the abutments.

The access holes are plugged with plastic Q-Tip rods to prevent acrylic from closing off the opening to the abutment screw.

The denture is now processed to the abutments using fast-set denture repair acrylic. This is achieved 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 is held firm until the acrylic cures completely. At this time, the Q-Tip plugs are removed and the denture in converted into an implant-supported hybrid denture. All excess acrylic and most of the denture flange is removed to make a high water type appliance.

After the appliance is adjusted, the underside is polished and glazed for a smooth finish that facilitates proper hygiene (Figure 6).

The hybrid is then attached back to the implants. The screws are torqued to 35 Newtons and the access holes covered with cotton and cavit.

The patient left the day of surgery with a fixed hybrid denture (Figure 7) that served him for three to four 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 three months, after which he was able to resume eating normal food.

The final restorations were delivered in four months. The patient is extremely pleased with the final outcome (Figure 8).