One thing I love about Smart Denture Conversions is that I can use it either at time of surgery (if stability allows) or after a period of osseointegration. Today I converted a maxillary denture to fixed provisional on 5 implants. The implants were placed six months ago and due to insufficient primary stability, we placed healing abutments instead of loading. Today, I removed the healing abutments and placed 17 degree MUAs on the 3 anterior implants and 30 degree MUAs on the 2 posterior implants. Because the tissue had conformed to the straight healing abutments there was a significant amount of tissue "bunching" up over the MUAs. Because the separable fasteners are very low torque, I couldn't use the separable fasteners immediately on the 2 posterior implants. I placed the 3 anterior Ti bases with the separable fasteners and the 2 posterior Ti bases with the normal prosthetic screws (so I could torque it and be sure for complete seat.
I then sent the patient for a panoramic radiograph while I stepped to the adjacent operatory and extracted a tooth for another patient (#7 if you wanted to know). When the panoramic was completed, I reviewed it and saw that the Ti bases were completely seated. Sufficient time had elapsed for the tissue to relax around the 2 posterior Ti bases, so I switched out the normal prosthetic screws for the separable fasteners. Now the tissue was not impeding the separable fastener from completely seating the Ti base. Ready for pick-up. Today I used Sterngold's EZ Pick-up which is a bis-GMA product and requires preparation of the denture with a bonding agent light cured in the Triad 2000 curing unit for 2 minutes. I used 2 syringes: 1 was used by my assistant to fill the denture while I used the 2nd to inject directly around the Ti bases in the patient's mouth. Denture was inserted and patient set the bite. We waited a full 5 minutes. Removed the prosthesis with no troubles and began our laboratory phase.
We used this as our final impression as well, so I made a master cast and duplicated the prosthesis on the master cast with alginate to later be digitized with my lab scanner (Straumann Series 7). It's actually less patient time in the chair for me to do it this way than to do the digitization with the patient in the chair. However you choose to do it, be sure to index the master cast prior to any scanning or duplicating. This will greatly assist the design phase.
So, we now have everything we need to submit to the lab for the final prosthesis, but first we are going to play around with design to try to improve some of the patient functional and esthetic concerns. We will do this simply with inexpensive 3D printed prototypes until the patient "buys off" on the proposed design. Luckily the patient wants to flare the teeth a little and move them anteriorly which should improve the screw access channel on the mandibular left anterior implant which currently comes straight out the facial of #24. (Not a big deal in the interim with Smart Denture Conversions because I didn't have to destroy the tooth in the conversion process!)