Wednesday, February 12, 2014
It is important to note that with a few simple tips restoring implants can be the easiest cases you will do on any given day.
The first tip is a necessity. Take an x-ray before you take the implant level impression. You want to verify that the impression post is down completely before you capture the impression.
As we see in Figure 1 (at left), it is possible to feel as if the impression post is down when in actuality it is not. If the post is not down, the crown designed from this impression will seat high. A quick x-ray can tell you if the post needs to be adjusted before you capture the impression. It also is a great idea to send the x-ray to the lab. On a close tray impression, they have to reinsert the impression post. The x-ray can aid in making sure it's in the correct position.
This second tip is only necessary if your impression post has the screw hole at the top. If so, be sure to block out the screw hole before you take the impression. If this is not done, this will cause a positive protrusion in the impression and your abutments will not seat properly.
The last tip provided here is one that will take a lot of the stress out of restoring implants. As we know, abutments can seat in multiple positions depending on the implant system being used. We have seen as many as eight different possibilities. If not placed correctly, you will feel like you are trying to solve a complex puzzle as you try different abutment alignments while your patient is wondering what is taking so long.
Fig. 2 The implant abutments are left in the jig while on the model.
Labs that have an expertise in restoring implants will always provide a jig, and most will do this at no cost. They understand that your success will make you want to do more implants in the future. As you can see in Figure 2, the abutments are left on the model with the red DuraLay jig in place.
Fig. 3 The implant abutments are unscrewed from the model but kept in the jig to retain their positioning.
Unscrew the abutments from the model but keep them in the same position in the jig as seen in Figure 3. Place the jig with the abutments in the mouth utilizing the same position it was in on the model.
Fig. 4 The jig is left in place while the abutments are hand tightened.
Hand tighten the abutments while the jig is in place as seen in Figure 4. At this point it is business as usual. Try your crown or bridge in normally. Once you are satisfied, be sure to torque your abutments to the manufacturer specifications. Our lab has seen thousands of cement retained cases that had to be cut off and redone because the abutments were not torqued and came loose over time.
In business, it is important to know what drives your economic engine. Implants can be our industry’s Ferrari, as long as you follow these simple steps. Once you are comfortable with them, you will realize that restoring implants can be among the easiest and most profitable parts of your practice.