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Delivery of all on 4 or other implant supported prosthesis
Delivery of all on 4 steps. Should now have the prosthesis and a set of NEW screws.
- Remove healing abutments or temp prosthesis
- Ensure multi-unit abutments are torqued down at company recommended torque
- Seat prosthesis and Sheffield test
- Hand-tighten the prosthetic screws, alternating from one side to the other.
- Once 2 in, one each side, check ischemia. If still there in 3 minutes remove and reduce area and polish.
- Tighten the screws to 15Ncm. When all screws done then go back and recheck all at 15 Ncm. Use whatever the implant company is recommending for torque, 15Ncm is common torque for going to a MUA.
- PTFE with neosporin and temp material for now (final NV). If using angled screws for an angulated screw channel ASC then use blue PTFE. There are many companies that make angulated screws now and all probably will. This will help future docs know what is going on.
- Fine tune occlusal adjustments check with Kerr indicator wax. PM adjust lower buccal incline buccal cusp Molar area adjust upper lingual incline buccal cusp
- Give them “Massad” home care brush and instruct patient on home care and oral hygiene.