Phase I

It is tempting for dentists to shortcut this critical planning in a desire to move quickly into implant treatment. But high-quality long-lasting results depend on careful planning and preparation.

This is not a step to be taken lightly. A complete assessment of risks requires a thorough understanding of your medical condition and your current state of health. Successful dental implant treatment takes place in a framework of total body health.

For example, if there are issues such as smoking that could increase the risk of failure, you may want us to help you with that.

A shortcut that some dentists take is to place the implants the day the teeth are extracted. If there are diseased teeth, this is a recipe for post-operative infection and dental implant loss.

We’re not just putting teeth in your mouth. Chewing movements are complex, and teeth need to be positioned and shaped properly to function. Position and shape are also important to esthetics and proper speaking

In Phase I we accomplish the following tasks. Not all of these will be required for each patient – it depends on the complexity of your case and your own individual needs. If you do not need extractions, for example, the alveoloplasty steps and relines of your prototype denture may not be required:

    • Complete medical history and review.
    • Evaluation of risk factors and possible implementation of behavior modification treatment.
    • Selection and use of antibiotics and local anti-microbial mouth-rinses. Infections present in the mouth and especially those associated with diseased teeth need to be under control before the placement of implants, or the risk of failure is high.
    • Facial and dental analysis
    • Diagnostic facial and dental photography.tom-composite

      (Photographs are Tom’s “before” pictures. Check the list of featured pages on the right to read more about Tom’s case.)

    • Coordination of the interdisciplinary treatment team.
    • facebowFacebow measurements of your jaw.These precise measurements will be used to create a mechanical duplicate of your jaw that will replicate your exact chewing motions. Compare your jaw to a swinging door – if it is out of alignment, it doesn’t close properly. Similarly, if your teeth don’t harmonize with your jaw movements, it can be a source of pain and discomfort.
    • Mounting of study models in the laboratory on an engineering instrument called an articulator.
      articulator-lateral
    • A survey by a leading dental laboratory trade journal revealed that fewer than 5% of cases submitted to laboratories are submitted on articulators.
    • Bruce Keeling, CDT

      Bruce Keeling, CDT

      Meet with the master dental technician who will custom fabricate your dental prostheses.Dr. Chal’s technician, Bruce Keeling, CDT, has devoted his career to removable and implant-supported restorations, and is an expert who is in high demand as a lecturer.

    • Make alveoloplasty models, which are “redlined” to assist the surgeon in visualizing how to reshape the bone to better receive the prototype dentures.
      alveoplasty-model
    • Make alveoloplasty surgical guides which will be sterilized and then used by the surgeon as a guide for reshaping your bone in conjuction with the extraction of your diseased teeth.
      alveoplasty-guide-1
    • This procedure also facilitates the later placement of the dental implants.DiagnosticManyCTs
    • Next we proceed with imaging. This is another area that sets our practice apart. We are very sophisticated in this area. To read why and to get more information about the critical importance of careful preparatory diagnostic work, please read our page on implant diagnostics, which is also linked sequentially at the bottom of this page. We use CT scans for all our implant cases, but not just any CT scan. We work with a specialized imaging center that exists only for dental imaging. Our team radiologist, Dr. David Hatcher of Sacramento, personally trained the staff and calibrated the equipment so that it delivers images of uncompromising clarity.
    • These three-dimensional cone beam CT scans of your upper and lower jaws are viewed by Dr. Chal and also sent to Dr. David Hatcher for interpretation.
    • David Hatcher, DDS, MSc

      David Hatcher, DDS, MSc

      Dr. Chal confers with Dr. Hatcher, reviewing the analysis of the CT scan and screening for any underlying pathology that may be present in your face or jaws.

    • Fabricate the prototype dentures, so that you will never be without teeth during this entire process. This will be used as an architectural guideline as you move forward into implant-supported restorations. This is of paramount importance. Other offices place the implants and design the teeth around the implants. We position the teeth first so that we can obtain optimum function and esthetics and then design the implants to support the teeth.
      prototype-denture
    • The prototype denture will also be converted into a CT scan guide (Chal-Hatcher guide™) that coordinates the functional and esthetic placement of your teeth with the jawbone, fixing their exact placement.
      chal-hatcher-guide
    • Fabricate the dental implant attachment spacing guide.This guide helps gauge the space available inside a denture or hybrid restoration for connectors. The connectors are what attach your teeth to the jawbone. If space is limited, then only snap-on dentures can be used. If space is more abundant, then you have the option of using whatever system you would wish, such as the use of titanium CAD/CAM bars.
      surgical-space-guide
    • Dr. Chal meets with the surgeon and together they determine the optimum size, diameter, length, and shape of implants for your case.Many dentists shortcut this process and just eyeball the placement of the implants, but any compromise here only increases the risk of failure of the implants. Dr. Chal and his surgeon use precisely calibrated templates of the exact implants that you will be given in order to insure there are no surprise sinus perforations, nerve impairments, or other perforation accidents during your surgery.

      He is holding the calibrated template in his right hand and placing it up against the CT scan.

    • A surgical guide is created to fix the placement of your dental implants. Placement is based on the esthetic and functional requirements of your case, and success of the case requires adequate inter-implant space to be allowed.
      calibrated-template
    • A second surgical guide is constructed to fix the angles and inclinations of the implants. Improper angulation is a strong risk factor for failure.
      surgical-angulation-guide
    • Following any extraction surgery, there will be one or more soft relines done inside your prototype denture.
      soft-liner
  • Once the tissue has healed enough after extractions, a laboratory hard reline will be performed on your prototype denture. The cost of only one hard reline is included. If you do not proceed in a timely fashion into phases II and III, additional relines will be required at additional cost

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