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Restorative Driven Implant Treatment: From Immediate Temporization to Final Restoration Go online for in-depth content by Paresh B. Patel, DDS When dentists place implants, a decision is typically made — depending on the quality of the bone encountered during osteotomy preparation and the degree of primary stability obtained — to immediately load the implant with a temporary abutment and provisional crown, or to place a healing abutment on the implant to better protect it from occlusal forces. Stock components for either approach typically have the disadvantage of being round; thus, as the soft tissue heals around them, the ground is laid for an unnaturally shaped emergence profile on which a final restoration with less-than-optimal esthetics must be created. While the development of CAD/CAM techniques made possible the creation of custom, anatomically shaped components, their use has been reserved for producing the definitive abutment, and doing so introduced uncertainties about the total cost of treatment — until now. The introduction of the Inclusive ® Tooth Replacement Solution from Glidewell Laboratories changes this substantially. Ingenious in its simplicity, the “tooth-in-a-box” concept behind this solution makes it easier to place an implant that will support the best possible final crown, while maximizing treatment options and eliminating all uncertainty about total cost. For a single price, the dentist receives an implant and all of the components necessary to sculpt the soft tissue and shape the final emergence profile, no matter what conditions are encountered during implant placement. The following case illustrates use of the Inclusive Tooth Replacement Solution to replace a patient’s maxillary premolar, employing conventional diagnostic methods. Case Report A 42-year-old female patient presented with an unremarkable medical and dental history. Her chief complaint was a missing maxillary left premolar, which she lost after failed root canal treatment. No socket preservation was done upon removal of the tooth more than nine months earlier. Since then, the patient had been functioning without any prosthesis. She wanted to replace the missing tooth with an implant, and stated she was willing to continue living without a temporary crown if implant primary stability could not be achieved. Thorough clinical examination — including diagnostic impressions, bone sounding and a panoramic radiograph — revealed adequate width and height of bone at the premolar site. Although some collapse of the buccal bone was evident, it was determined that a sufficient amount was present to proceed with implant therapy. Soft tissue examination revealed that the attached gingival volume was adequate and the tissue was healthy. Because more than 7 mm of space existed between the two adjacent Figure 1a: Custom healing abutment, custom temporary abutment, BioTemps provisional crown, custom impression coping 52 – www.inclusivemagazine.com –
teeth, placement of a 3.7 mm diameter implant would leave more than 1.5 mm of space between the implant and each adjoining tooth, a distance generally acknowledged as sufficient to reduce marginal bone loss and the resultant negative loss of papillae. 1,2 Figure 1b: Prosthetic guide The optimal treatment plan called for using the custom temporary abutment if 35 Ncm of torque could be obtained. The patient would then have to comply with a soft diet during the progression of healing from primary to secondary stability. If primary stability could not be achieved, the custom healing abutment included as part of the Inclusive Tooth Replacement Solution would be placed. Clinical Procedure Figure 2: Prosthetic guide seated Figure 3: Initial osteotomy Figure 4: Custom healing abutment seated Figure 5: Custom temporary (occlusal view) A full-arch polyvinyl siloxane impression using Capture ® PVS impression material (Glidewell Laboratories) was taken, along with a bite registration. A shade selection was made and a digital photograph was taken. All of these were sent to Glidewell Laboratories, along with an Inclusive Tooth Replacement Solution prescription form. There, the information was used to pour a stone model of both arches to create the diagnostic study models for the Inclusive Tooth Replacement Solution process. Following scanning, the digital study models were used to fabricate a custom healing abutment, custom temporary abutment and custom impression coping — all with matching gingival contours — along with a BioTemps ® provisional crown (Glidewell Laboratories) (Fig. 1a). These items, as well as a prosthetic guide (Fig. 1b) that communicated to the dentist the optimal osteotomy position in order to ensure creation of an esthetic final crown, were all delivered from Glidewell prior to treatment. On the day of implant placement, the prosthetic guide was seated securely into place (Fig. 2). A flapless osteotomy was created (Fig. 3), beginning with a pilot drill, followed by a tissue punch and, finally, sequential widening of the osteotomy using the disposable drills packaged with the Inclusive Tooth Replacement Solution. A 3.7 mm x 13 mm Inclusive ® Tapered Implant was then placed. However, only 30 Ncm of torque was achieved. Because it was not possible to tighten the implant more than 35 Ncm, the custom healing abutment was utilized (Fig. 4). Five weeks later, the patient returned, the healing abutment was removed and the implant was found to be stable and healing uneventfully. The custom impression coping was connected to the implant and an impression was taken. Careful inspection of the custom impression coping confirmed that it featured the same gingival contours as the custom healing abutment, ensuring all minute details of the carefully sculpted soft tissue would be properly communicated to the laboratory. The custom temporary abutment – Restorative Driven Implant Treatment: From Immediate Temporization to Final Restoration – 53
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Inclusive Restorative Driven Implan
Page 3: Contents ALSO IN THIS ISSUE 14 Clin
Page 6 and 7: Publisher Jim Glidewell, CDT Editor
Page 8 and 9: Clinical Benefits of the Inclusive
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Page 12 and 13: Healing Phase As with any implant t
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Page 22 and 23: •Step 3: Milling of Custom Compon
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