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CLINICAL CASE REPORT
rotated into place with about 1 mm of space left between
the shoulder of the implant holder device and the metal ring
of the surgical guide. Using a manual torque wrench, the
implants were rotated into position so that the orientation
dimple was directed straight to the buccal with no off
rotation. The depth placement of the implants was set by
the surgical guide.
Each implant was torqued to 35 Ncm with the dimple to the
buccal and depth controlled by the surgical guide. An Osstell
® ISQ implant stability measuring device with SmartPeg
attachments (Osstell Inc. USA; Linthicum, Md.) was used in
each respective implant fixture, and a reading of about 80
was recorded in each implant site (Fig. 23). This value was
deemed to be excellent for the maxillary bicuspid area.
Phase III: Immediate Provisional
Restoration
The screw-retained custom temporary abutments were each
individually seated and a titanium retention screw was used
to secure them into place (Fig. 24). Each provisional abutment
retention screw was hand-tightened only (Fig. 25). The
milled provisional crowns were delivered, and the fit was
checked (Fig. 26). Remarkably, the implant fixture placement
was such that no rotation adjustment was required. The occlusal
relationships were checked with articulation paper to
verify that there was no occlusal loading. Also remarkable
was the fact that no mesial-distal contact adjustment was required
as verified by floss. The lack of proximal contact was
deemed to be very important as no undue lateral pressure
was to be exerted by the proximal contacts. The esthetic
result looked excellent from the occlusal, as well as from
the buccal (Fig. 27) and anterior views. The patient reported
that the shade match and esthetics were quite acceptable.
Figure 21: Drill in collimator of guide.
Figure 22: Drill series for the NobelReplace NP tapered implant.
The screw-retained custom
temporary abutments were
each individually seated and a
titanium retention screw was used
to secure them into place.
Each provisional abutment retention
screw was hand-tightened only.
Figure 23: The Osstell ISQ implant stability meter’s SmartPegs in place.
Figure 24: Screw-retained Inclusive Custom Temporary Abutment.
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