From: Jeffrey C. Hoos DMD
To: ROOTS
Sent: Friday, December 26, 2008 1:45 AM
Subject: Re: [roots] [implants] O.K how would you manage that? SYCHRONISITTEE

Just a simple ankylos case....NOT.  need the indexing for placement of abutments.
Temp upper bridge made from Radica on custom abutments. The case will be done.....
Lowers completed and then return to finish the top.
The canines were removed at time of placement of the temps.
The canines were used to hold the temps.
The left side lower had to be grafted so a delay in treatment.
Vertical is being maintained by the lower anteriors and upper anteriors.
Will post the completed case.
Patient is a man 35 years old that lost his teeth with advanced decay and nonrestorable.
An amazing patient and more importantly an amazing supportive family.
The case will be conventional C and B once the abutments are in place.
Anyone can do that ......even me. - Jeffrey C Hoos DMD FAGD



Jeff, What made this case particularly challenging...the patient’s requirements, or the use of the Ankylos
system with multiple abutment fixed prostheses? What are the unique challenges you encountered? - Hank

I will post many more photos showing the progress of the case.
The difficulty of the case was the management of the patient because he would lose, break, or do something to the temps.
A surgical stent was used for implant placement based upon the location of his teeth.  Because of his age....no grafting
was needed. I want to turn this into C and B as fast as possible.  The parents did not want anything removable because of loss.
SO...the implants were placed keeping the canines of the temps.
The temp was placed after the custom abutments were made.
There was no temp try in because I felt I could make modifications to the temp... None were made.
The occlusion was not an issue because the only mandibular teeth were the lower anteriors.   Anterior stops on the lingual of
the upper teeth.
The impression method was very specific........open tray....with ligiture wire connected with GC in multiple steps.......
connected around the abutments.  Then very small space.....no shrinkage with the GC as compared to Duralay.......
Blue velvet (Jmorita) used to do the pick up... 85 durameter material in a open metal tray.  This is the most accurate method.
Now the case is connected for strength......but the final will be singles except the 5,6,7 bridge and 10,11,12 bridge
I will build it with the ideal occlusion......
Now the big question......will it be porcelain to metal or a hybrid material on metal.
But with the ankylos it will look perfect cosmetically.
I was thinking about using zirconnium abutments but decided on metal........
This case will be easy now because it just c and b.
More later if you want. -  Jeffrey C Hoos

Dr Hoos, thanks so much for sharing your material with us, looking forward to the next photos of this case - Jose.