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ePaper created 2016-12-13, 09:04:25 | version 1.38.0
3_2016 18 the healing screw and place a temporary abut- ment. The temporary partial was adjusted to ac- commodate the added height of the healing abut- ment (Fig. 5). Patient was instructed to return to restorative office for definitive restoration of the implant in approximately three weeks. Patient was appointed with restorative office for evaluation and to develop necessary records for laboratory fabrication of the definitive resto- ration. Implant site was evaluated and deemed adequately healed to proceed with restorative procedures (Fig. 6). Healing abutment was removed and a closed tray impression coping was fitted onto the im- plant (Fig. 7). Radiograph was taken to confirm complete seating of the impression coping. A full-arch impression was taken with heavy body PVS impression material (Panasil Tray Soft, Heavy Body Regular Set, Kettenbach GmbH) (Fig. 8). Healing abutment was replaced once impres- sion was taken. A bite registration (Futar D Fast Set Kettenbach GmbH), new opposing impres- sion (Silginate plus Panasil Light Body Fast Set, Kettenbach GmbH) and shade map were taken. All clinical product was sent to laboratory along with shade photography and a complete written prescription. A PFM high noble crown and Atlantis gold hue custom abutment were prescribed. The abutment was ordered as tissue contouring with 1 mm deep margin placement circumferentially (Atlantis, Dentsply Implants). The use of a custom abutment allows modifi- cation 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 cus- tom stained. Lab was cautioned that occlusion on this restoration was in the path of patient’s cross- bite transition from normal to crossbite. The laboratory (Drake Precision Dental Lab- oratories, Charlotte, N.C.) partnered with Atlan- tis (Dentsply Implants) for abutment design and milling and then fabricated the PFM crown (Figs. 9-10). The patient was appointed for definitive restoration delivery. Delivery appointment was uneventful. Heal- ing abutment was removed and the Atlantis abutment was placed (Fig. 11). Due to positive tissue pressure from tissue contouring, the abut- ment was slowly placed with incremental turns of the retention screw. Tissue blanching was carefully observed. The abutment was fully seated and within five minutes tissue blanching had disappeared. The Atlantis abutment was torqued to manufac- turer’s specifications (30 Ncm). A radiograph was taken to confirm final seating of the abutment. The PFM crown was tried on and interprox- imal contacts adjusted to allow complete seat- ing 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 provid- ing a light occlusal contact that became normal in intensity upon biting force.2 All functional contact was adjusted to be in minimal contact Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 10_Gold hue Atlantis abutment on analogue model. Fig. 11_Gold hue Atlantis abutment in place. Fig. 12_Cementation jig. Fig. 13_Final patient lateral smile. case report _ aesthetic replacement