Tom’s Story

Tom came to Dr. Arthur Chal with advanced periodontitis. There was no way to save his teeth, because of the extensive bone loss, and the tooth mobility.


To begin treatment, Dr. Chal created a prototype denture for Tom and found the ideal positions to place the teeth for his best function and appearance. Popular dental implant clinics rarely take the time for this step, which is why patients end up with uncomfortable teeth, distorted facial appearance, or the inability to function properly.

Only after the proper positions for the teeth are found does Dr. Chal create the instructions for the surgeon as to where to place the dental implants. Tom’s surgery was performed by Karel A. deLeeuw, DDS, MD at Mayo Clinic Hospital Phoenix Arizona.

From that point, the case is primarily an exercise in precision—making sure the final denture/implant hybrid restoration fits the dental implants so precisely that there is no twisting force or other unwanted stress on the implants. This is what assures longevity of the implants. The key to having dental implants that truly last is to have a perfectionist take care of these steps.

After the surgeon then places the implants, a temporary titanium coping is placed on these implants. Then a precision impression is taken of these copings to enable Dr. Chal and his implant technician to create an exact model, re-creating the positions of the implants in relation to the surrounding tissue.


Impression taken in the first clinical appointment.

Preliminary cast with impression copings.

Master impression after removal from the mouth.

Master impression with implant replicas. The pink material around the implant replica next to the impression is artificial tissue.

The master cast is now ready to be used to fabricate a fixed hybrid implant restoration.

Stabilized occlusion rim to capture the jaw relations. The holes are to allow Dr. Chal to screw the rim directly to the implants, which insures an exact measurement of the proper position that the teeth should be in.

Face bow transfer.

Case transferred to an engineering instrument and the teeth set in wax.

Verifying the proper vertical dimension of the case.

Pictures of computer-assisted design of custom milled titanium bar.

Custom milled titanium bar on the master cast.

Teeth set in wax on top of the bar to verify the fit and accuracy of all the components.

Try-in of milled titanium bar in the mouth.

Clinical try-in of teeth in wax and the bar to verify proper jaw relations, function, phonetics, and esthetics.

Verifying the jaw relation on an engineering instrument.

Final wax-up of fixed prosthesis for processing. Notice that a fixed hybrid restoration replacing both teeth and gum tissue is much smaller than a conventional denture.

The final fixed prosthesis after processing. The screw access holes are then filled with tooth resin so that they are undetectable when the hybrid is finally placed.

A very satisfied patient. His comment when he was finished was that
his teeth now feel so comfortable and solid that it was like “hitting the sweet
” with every swing of a golf club.

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