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ePaper created 2016-06-01, 10:23:49 | version 1.38.0
implants 2_2016 I C.E. article_ esthetic replacement of maxillary premolar 06 I instructed to return to restorative office for defini- tive restoration of the implant in approximately three weeks. Patient was appointed with restorative office for evaluation and to develop necessary records for labo- ratoryfabricationofthedefinitiverestoration.Implant site was evaluated and deemed adequately healed to proceedwithrestorativeprocedures(Fig.6). Healing abutment was removed and a closed tray impression coping was fitted onto the implant (Fig. 7). Radiograph was taken to confirm complete seat- ing of the impression coping. A full-arch impression was taken with heavy body PVS impression material (PanasilTraySoft,HeavyBodyRegularSet,Kettenbach GmbH)(Fig.8). Healing abutment was replaced once impres- sion was taken. A bite registration (Futar D Fast Set Kettenbach GmbH), new opposing impression (Silginate plus Panasil Light Body Fast Set, Ketten- bach GmbH) and shade map were taken. All clinical product was sent to laboratory along with shade photography and a complete written prescription. APFMhighnoblecrownandAtlantisgoldhuecustom abutmentwereprescribed. Theabutmentwasordered as tissue contouring with 1 mm deep margin place- mentcircumferentially(Atlantis,DentsplyImplants). The use of a custom abutment allows modification of transmucosal tissue profile and to ideally position margins. Tissues were previously shaped with the ovate pontic of the temporary partial. The final crown was planned to be chairside custom stained. Lab was cautionedthatocclusiononthisrestorationwasinthe path of patient’s crossbite transition from normal to crossbite. The laboratory (Drake Precision Dental Labora- tories, Charlotte, N.C.) partnered with Atlantis (DENTSPLY Implants) for abutment design and milling andthenfabricatedthePFMcrown(Figs.9-10).Thepa- tientwasappointedfordefinitiverestorationdelivery. Delivery appointment was uneventful. Healing abutment was removed and the Atlantis abutment was placed (Fig. 11). Because of positive tissue pres- surefromtissuecontouring,theabutmentwasslowly placed with incremental turns of the retention screw. Tissueblanchingwascarefullyobserved. Theabutmentwasfullyseatedand,withinfivemin- utes, tissue blanching had disappeared. The Atlantis abutment was torqued to manufacturer’s specifica- tions(30Ncm).Aradiographwastakentoconfirmfinal seatingoftheabutment. ThePFMcrownwastriedonandinterproximalcon- tacts adjusted to allow complete seating of the crown. Occlusion was marked with appropriate articulation ribbon and adjustments were accomplished, with particular attention to functional path and centric contacts. The final occlusion respected the cross bite while providing a light occlusal contact that became normal in intensity upon biting force.2 All functional contact was adjusted to be in minimal contact during excur- Fig. 9 Fig. 9_Crown and abutment on analog model. Fig. 10_Gold hue Atlantis abutment on analog model. Fig. 11_Gold hue Atlantis abutment in place. Fig. 12_Cementation jig. Fig. 10 Fig. 11 Fig. 12