Rehabilitation of a Full Arch Utilizing All-on-4™ Treatment Concept, Part 4

Open, my dear. Open a little. So what I'm doing here, I'm actually using a 1 inch Teflon tape to cover my suture. So when the acrylic actually doesn't get on the wound. So we just marked it by pressing it on the abutments. And now I'm going to take it off and we're going to use a rubber dam punch to make the holes. This run right there. Go ahead and do that. Okay. I think we have the denture. Let's try it on. Good, so it fits. Greg, I think if we can cut the back so I could have her, you know, bite down. Can we cut this, Just shorten the cylinders a little bit, you know, because I don't want her to be too, too forward. I think we're seated. Open my deer a little bit. I'm going to check that the back is seated. So yeah, let's cut the cylinders a little bit. Yes. Okay. So I think if we can cut it right there and that right there. Okay. Yeah. So they're marked. Well, let me put that down over here. 4x4 gauze. Okay. So I'm going to unscrew this cylinder so we can reduce the size. You can keep that on the side for now, Helder, because we're not ready for that. Okay, Greg. So this is the right side. So important to work with, experience, dental thick measurements. Here's a little screw. Makes my life easier. Okay. So the reason why I want these shortened to begin with is because I want Ana Maria to be able to bite down just to make sure this prosthesis, you know, when we pick up these abutments is not too far forward. Okay, There we go. We're not going to put on the white caps. I think we should be okay for a few minutes now. I'm just going to put a bit of pressure over the ridge here. Let me see the Teflon tape. Make this more interior. Make this one longer. There. Let's take another one. Give me, give me another one. Let's try another one right here. Holder. Is that it or no? Okay. You kind of make it based on the other one. Go ahead and press it down it. Okay, There you go. If you need to put on a piece of paper from this and pull punch through both. You know what I mean? Or just it might be easier. Ra. Dr. Moldovine. Yes. Dr. Harris here. Could you explain why you're using Teflon T versus rubber dam? Good question. The rubber dam tends to be a little bit thicker and it doesn't adapt to the tissues. What you'll see shortly is like the Teflon tape will actually stick like Saran wrap to the tissues. And I usually use a Q tip to set it in place. And it doesn't move. But the rubber dam, you know, it just has memory and it doesn't adapt like Saran wrap. And second reason, Teflon tape is a lot thinner than rubber dam. So you won't get that space between the denture and the rubber dam. Good. It's okay, no problem. Great, huh? I have four cottons here, so the scrags is all. So now look at the cylinders and I need her to bite it. Give me 4x4 gauze. Looks like Reg is ready. He's coming back. But we'll get ready to place the cylinders back on. Almost time for lunch. We're getting there. So what will happen next? I'm going to put the titanium sleeves here. Perfect. Screwdriver please. We're gonna start with the right size. Yeah, the 4x4 is in right side. You see the mark, right? Uh huh. That's the one we're gonna start with. Make sure we have no bleeding here. There's a little bleeding there. If you're gonna rinse it off, that'd be great. Think it dried up a little bit. So what happens is it'll get sticky there. Try to keep these as clean as possible. Good. Ania, open for me my dear. Thank you. Sorry to wake you up here. Okay, again I need to clean the cylinders, the compartments first. Water. Okay. Okay, one more sleeve. Good. Let's check the denture. Actually we can put the bite down, my dear. Bite down all the way. Okay, good. Yeah, she's hitting on seven. Okay, seven and ten. Just a little bit. I would say open a bit. Posteriors are great. Let's see. Here's my little marker. Okay, there we go, four by four guys. For the posterior. A little bit more reduction here just so I could have her fully close. Obviously we don't want to take too much off. This is done. There we go. Okay, so let's put on. We have the other two that are working. So we're going to put on our teflon tape here. I want to dry this ridge. Take that off for a second. I'm going to need a Q tip. Gwent, just wet it for me. Okay, so you can see here, you can actually tap this over the area here. I'm going to stretch over the last abutment and I should be able to still seat the multi unit abutments even after I Place this. Can we switch the monitor to the patient, please? Thank you. It's a little bit of a bigger gap that I like it to have, but I don't have any knots there, so I'm not too worried about it here. I need to remove the little loose piece right there. But essentially this will just help me cover all the stitches here. And you just take a wet Q tip and adapt it onto the tissue. Okay, there you have it. Just want to make sure none of the teflon tape is sticking onto the abutments. It is a little bit over here. Yes, go ahead. I want to remove a little bit of it from the bottom here and see, even if you have a fold in it, it's still thin enough that I could seat this. Okay, ready? Awesome. Okay, I need a four by four gauze. So that one was seven? Yes. All right. Am I just a little grass bank there? Make sure nothing drops down. Great. One more. Now just want to make sure this one's seated. Let me have an elevator here and a probe. I'm catching a little bit of the tough one today here, so. Okay. And suction that. Okay, perfect. Looking good. All seated. I could see here on the palatal that it's fully seated. Let me go ahead and bite down right there. Bite down. Okay, good. When I take this out because we definitely want to see in the smile. Make sure this is not crooked. Very nice. Okay, so we know that's how we want to disposition maybe a little bit. Go ahead and bite that one more time. Okay, good. The midline's right on. Perfect. Open. Okay, so I think we're ready to load. We prepared already some cotton here for the scraxis holes. This might be a little too big. Let me have a smaller one. This is right here. I'm going to start with a smaller one here for the front. Even smaller than that helder for the two interior ones. Give me a probe. So we just want to make sure that no acrylic is going to go in the scoraxis hole. Okay, good. And let me put this one where it needs to be. Excellent. Let me have a Q tip, please. Not a. Not a. Yeah, clean one. I just use it to press here. Okay. I'll make sure these are dry. This moved a little bit. Let's put it back in place. Retract. And very important to keep the area as dry as possible here, especially the cylinder. See, as soon as we took out the retractor, there's a tendency to do that. So go ahead and give me the Horsesher retractor. For now. I'm going to put that in place just so we can dry the cylinders properly and then. Okay. All right, Greg, I think we're ready. Go ahead and dry it. Yes, go ahead. All right, go ahead and start mixing. Yes. Okay, holder. So I need the Q tip assigned on an instrument so I can remove the excess acrylic from the access holes after I see the denture. Perfect. Right here. Go ahead and bite down. Let me see. Bite, bite, bite, bite together. Open, open for me. Hold, Holder, hold right here. Hold the retractor. Awesome. Okay, so I'm injecting the acrylic all the way around. I want to make sure that it gets in all the proper places here and last. Okay, hold that. Just want to make sure we secure it all the way down and around. When you bite down for me, my dear, take the retractor out. Okay. Bite down. Hold it tight. Okay, hold it. Hold and squeeze. Okay. All right. I need it back. Perfect. Open. Yeah, we can see here. Want to make sure that these are completely uncovered here. Very, very important. Don't rush this point. Okay. What happens is we want to make sure that this stays in place. Go ahead and suction for me, Helder. Keep it as dry as possible. The back of the throat a little bit there. And I want to leave the acrylic here to see. To really cure for a good five minutes, maybe 10. So at this point, you can. What we're going to do, just wait here. So if you guys want to go to lunch, you can do that. And what we're going to do, I'm just going to give this to Greg to finalize. And if you guys want to stick around and watch your mastery. Absolutely. Yeah. So perfect. Yeah. It's getting warm. Definitely don't want to remove this until it fully cools off. Yeah, Very nice. I'm gonna wait till the heat fully goes away. Let me remove this a little bit. It's already hard in the dry. Go a little. So what could happen is that maybe one of the abutments didn't get picked up, so we might have to go back and secure it. We're going to find out. I can remove the. It. Make sure I get this acrylic off here so I can put in the screwdriver. I need a 4 by 4 gauze. Quite a few. Okay, good. I can engage there. Good. Not yet. Just want to wait a little bit longer here. Is it cooled off yet? Sorry. Almost. Still warm. Still warm. Yeah. Safe to remove it. Okay, hold on. It sometimes the screws come out. Sometimes they don't. Let's see. Always have extra screws, so you never know when you lose. I mean, if you see how small these are. There you go. Helder, you can. Yes. Especially if you have great floors. See? I mean, look how small these screws are. So make sure you have extras. Put it in there. 3. Just make sure this one is fully still in there. I have one screw still in there, so. Okay. Looks like stuck on the acrylic there. So what? First thing, I'm going to check to make sure these are fully engaged. Cotton plier, please. Yeah. Engaged. Engaged. Engaged. Perfect. So back in the lab, I mean, I could take off some of this Teflon tape. It just peels off. All the sutures are intact. I don't see any sutures stuck on here. Okay, so here we have it. All right. We have all four engaged. So Greg, what he's going to do is just going to finalize this in the lab. There's a little void right there, but overall it picked up well. Yeah. Okay. It's one screw still actually on the other side. Yeah. Number seven. Okay. So in the meantime, we're gonna put on some white caps. Okay. Because it's gonna be a little while until we finalize this. So let's put on some white gaps just to make sure the tissue doesn't close. Wash your ret. Last one. Yes. If we have to leave the patient at this stage. Yes. How late or how early we can go back to. So from the literature, we know that the bone actually rough knee implant starts remodeling. And after a week, it's not safe to screw and unscrew things over the implant because the osteoclast started doing some resorption, some remodeling already around the implants. So I would say within a week is safe. Within five days to screw and unscrew things over the implants. Then, of course, it depends on the stability of your implants as well. Ideally, I like to load things the first day, but I know some practitioners actually wait until the next day to finalize the prosthesis, especially when you don't have a lab close by. Luckily, da Vinci actually travels when I do these cases. So we're able to do these cases all under one route. Greg is right next to me. I hand him the prosthesis and he does the conversion. That's the ideal. A lot of my patients, again, have teeth. A lot of my cases, so they don't like to go home without teeth. They're here because they don't want to end up with a denture. So they want to wake up and they want fixed teeth. There's definitely a phobia out there about, you know, having dentures. So it's a great. This treatment is a great treatment for dentate patients who have terminal dentition. We have to remove it, and then we can give them something fixed essentially the same day. Okay, So I think at this time, let's head to lunch. I'll see you guys out there. I think we're all hungry. You have a smoothie, and when we come back from lunch, I'll talk a little bit about what we did and some of my experience I'll share with you.