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A Simplified Approach

Can a simplified implant protocol really have a significant impact on my practice or patient satisfaction? The answer is an undeniable - Yes!

Many years of research and clinical study support the use of a fixture level index to determine the intraoral position of the implant at the first surgical procedure. By adding this 2-3 minute procedure to the first surgery, the surgeon makes it possible for the restorative phase to begin much earlier than in a traditional method. The fixture level index is the foundation on which the simplified protocol is built.

The Simplified Protocol is a method of practicing implant dentistry that will have long lasting benefits for the surgical specialist, the restorative doctor and the patient alike. Working together as a team, the clinicians are able to reduce overall costs, decrease the number of patient visits required to restore an implant case and significantly improve the final outcome for the patient.

The Simplified Protocol can be broken down into four stages or four patient visits - two surgical and two restorative.

Surgical Visit #1:

Surgical Specialist places the implant and prior to concluding the procedure, takes a fixture level index.


Surgical Visit #2:

Surgical Specialist exposes the implant and places the Atlantis Abutment and provisional restoration.


Restorative Visit #1:

Restorative Dentist checks tissue healing and makes final impression.


Restorative Visit #2:

Restorative Dentist removes the provisional and delivers the final restoration.

To simplify the implant process even further, Atlantis offers an innovative product known as the Atlantis Gemini abutment. Simply stated, the Atlantis Gemini abutment is a second abutment that is identical to the original abutment. The Atlantis Gemini abutment is sent with the master cast to your favorite crown-and-bridge laboratory for fabrication of the final restoration. Fabrication of the final restoration directly on the Atlantis Gemini abutment ensures a precise fit, eliminates the need for a final impression, and saves valuable chair time.

This protocol can be adopted by any dentist and integrated into any practice. The time and cost savings allow the practitioner to increase the number of patients in their practice and improve the bottom line while simultaneously providing patients with a superior solution for the replacement of missing teeth.

References:

Initiating Restorative Procedures at the First-Stage Implant Surgery With a Positional Index: A Case Report. Reiser, Gary M., D.D.S. et al., IJP & RD, 1992

Surgical Template and Stage One Indexing, Hochwald, D.A., D.D.S. et al., JPD, 1991

Special Surgical Consideration in Implant Dentistry, Rosenlicht, J.L., D.D.S., The Implant Society, 1990

Fixture Level (Stage 1) Index Technique

The Stage 1 Index Technique outlined below is supported by many years of clinical research. The research has shown that accurate capture of the implant fixture position at the time of implant placement facilitates the fabrication of an accurate master cast. The utilization of an accurate master cast in a "Simplified Protocol"; allows the clinician to deliver a customized abutment and provisional at the second surgery.

Materials Required:

  • Standard 1:1 Impression Gun (e.g. Henry Schein #100-0956)

  • One transfer coping, per implant fixture, sterile (coping size must match implant size)

  • One tube of index material (Vinyl Polysiloxane)

  • One mixing tip, per quadrant, sterile

  • Index baggie

  • Disinfectant (to sterilize finished index)

Procedure

Stage 1 Surgery

  • Implant placed in the jawbone, primary stability achieved

  • Surgical flaps remain open

  • Cover screw has not been attached


Select Transfer Coping

Steam sterilize the transfer coping tree and retentive screw:

  • Temperature: 132° C ± 2°

  • Exposure Time: 10 minutes (Full cycle)

    • Note: Exposure time is calculated after the temperature of the autoclave has reached 132° C.

  • Insert metal retentive screw into coping


Seat Transfer Coping onto Implant Fixture

  • Place retentive screw into top of implant and turn several times to engage screw

  • Gently turn transfer coping until seated on implant.

  • Use finger pressure to seat coping onto implant table

  • Finger-tighten retentive screw

  • Confirm coping is seated securely, verify radiographically


Apply the index material, first to the lingual

  • Syringe the vinyl polysiloxane index material around the transfer coping on the lingual and onto at least two adjacent teeth

  • Capture the transfer coping securely in the index material


Apply the index material to the buccal

  • Syringe the vinyl polysiloxane index material around the transfer coping on the buccal and again onto at least two adjacent teeth

  • Capture the transfer coping securely in the index material.

  • Applying too little index material or failing to capture the coping securely can result in an unstable or inaccurate index.


Remove & disinfect index

  • Once the index material has set (approximately 45 seconds) remove and disinfect the index

  • Ensure that index material has set prior to removal to avoid distortion of the index

  • Place index in plastic baggie and label

  • Attach cover screw to implant and complete Stage 1 surgical procedure