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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