Can you explain the process for visiting MAP for an implant retained prosthesis?

We meet with you, examine the involved area and discuss how we can help. All options are explained in detail. If you wish to see photos of others wearing the same type of prosthesis we will select appropriate cases from our portfolio of hundreds of prosthetic results. You can also handle sample prostheses that fit onto demonstration models. We answer all of your questions as clearly and completely as possible, and recommend other specialists when their services might enhance your restorative outcome. Prostheses that attach to bone-anchored implants are a wonderful option for many, but they do require a surgery. If this implant-retained type of prosthesis is an option for you we will begin coordinating as a team: you, your MAP anaplastologist and your doctor and/or surgeons we can recommend. Finally, we will have customized written materials for you to take home and review at your convenience.

We use a soft impression material to smooth over and around the involved areas to accurately record the important shapes that will result in a perfect fit of the prosthesis. Our material has a consistency similar to gel toothpaste, but after it sets in a few minutes it still remains flexible and lifts easily from the skin capturing and recording all the important details. The technique is similar to an orthodontist taking an impression of the teeth, or an audiologist making an ear mold for a hearing aid: simple, quick, and painless. From the impressions we are then able to produce actual casts of your contours that we will build upon.

The surgeon needs to know where the implants should ideally be positioned in your bone so that they will stabilize your prosthesis and also remain hidden beneath it. An excellent way for us to help the surgeon is to provide him/her with an actual silicone prosthesis that is already accurate in size, shape and the way in rests in its proper position on you. To do this, we use the casts we made from you and our scanning/sculpting procedures to prepare a wax prototype. After we verify the accuracy of the wax prototype it is molded and cast into the silicone surgical guide. Guide holes or slots are cut into the guide to indicate to the surgeon the ideal positions for the implants. It is then delivered to the operating room prior to your surgery.

In the operating room the surgeon positions the guide (also referred to as “positioner” or “template”) and marks where the implants should be placed. The implant fixtures are then firmly anchored into the bone. Holes are then made in the skin over the implants and small posts about ½” in length are then snuggly screwed into the implant fixtures. These posts are called healing abutments and they will remain in place only for the healing/osseointegration period. The implant placement procedure is often just a day-surgery and the patient is later allowed to go home that same day.

At some point during this time frame your surgeon will determine that your implant fixtures have fully integrated with the bone and that your skin has healed properly around the healing abutments. Your MAP anaplastologist will then determine the proper abutments to replace your healing abutments with. In doing this we take a few measurements and record the best attachment components and permanent abutments, and then special order them from the implant company.

Healing abutments are replaced with the final prosthetic abutments and attaching components. Then an impression is taken of the abutments and surrounding contours.

SCULPTING/DESIGNING:

You have plenty of opportunity to finally see your prosthesis taking shape as we painstakingly sculpt and check the fit of the wax prototype right on you. Our experience guides most of our critical design decisions such as how the prosthesis will transition with your skin. However, we appreciate the emotional aspect of this process and invite relaxed open discussions about personal preferences such as nasal shape, eye expression, etc. You will have plenty of opportunity to view the model in place and discuss nuances you would like to see. Our approach as artists and our emphasis on anaplastology are tailored to make this a restoring and positive experience for you. That’s why we sometimes decide to have an additional session either later that day or another day to take a fresh objective look at our progress, to double check the fit and margin transitions and to make all final refinements — unhurried.

COLOR MATCHING:

Your “skin color” is the result of an amazingly complex combination of pigmentation, vascularity and other physiological factors that you share with no other person. As MAP anaplastologists we use our clinical training and digital photography to record your basic skin tone and characterization. However, we rely most heavily on our visual acuity as artists to see, interpret and record much of the color defining detail that is unique to the area on your body being restored. The methods we use range from photographing skin character reference swatches to painterly application of silicone color into the fabrication mold. Color matching is sometimes combined with the sculpting session or it is done at the time the silicone is actually packed into the mold for polymerization (fabrication).

EXTERNAL TINTING:

After the silicone is polymerized and the prosthesis is removed from the mold it is trimmed, placed on our patient and meticulously hand tinted to add or enhance the tiny blood vessels, freckles and other simulations that make the prosthesis look just like the adjacent skin. The tinting session ranges from ½ hour to 1 and ½ hours, typically. Then the prosthesis is removed once more for its final preparations prior to delivery.

DELIVERY and INSTRUCTIONS:

Your prosthesis and its proper use will be carefully demonstrated in front of you. All the steps will be reviewed with you including; cleaning the prosthesis, cleaning your skin, placement of the prosthesis, removal of the prosthesis and proper storing of the prosthesis when not in use. You also will go home with full written instructions to refer to and our phone numbers in case you have any questions.

Sample timeline for receiving your implant-retained prosthesis:

Initial Visit:

• Day 1; Morning; Consultation/Evaluation/Impressions
  Afternoon; Surgeon Consult/Team Planning
• Day 2: Morning; Sculpting for Surgical Guide

…surgery scheduled…implants placed by surgeon…3-6 month osseointegration period…

Final Visit:

• Day 1: Morning; Abutments Ordered
• Day 2: Morning; Abutments Placed/Impressions
  Afternoon; Sculpting
• Day 3: Morning; Final Sculpting/Color Matching
• Day 4: Morning; Extrinsic Tinting
  Afternoon; Delivery and Instructions