Seating index
Torque wrench
In most instances it is not necessary to anesthetize the patient for the delivery of the restoration unless tissue recontouring around the implant is planned. Remove any temporary restorations, temporary abutments or trans mucosal abutments. Irrigate the inside of the implant with chlorhexidine and flush out any debris.
Install the final abutment with the seating index or the Sharpie mark towards the facial and only hand tighten the final screw with the driver. Place the crown over the abutment, if the crown appears to seat some degrees rotated remove the crown. Unscrew the abutment and rotate the abutment in to the correct position. Depending on the brand of implant, the abutment can have 3, 4, 6, 8, 12 or even 24 positions. Re hand tighten the final screw and take an x-ray to confirm proper seating of the abutment. Seat the crown over the abutment and adjust proximal contacts as needed. There only needs to be a single occlusal contact, preferably right above the implant. The occlusal contact should only be very light. Eliminate any lateral contacts on the implant restoration.
Remove the crown and torque the screw with the torque driver to recommended torque. Unscrew the screw slightly and retorque the screw again to specs. Place a cotton ball in to the screw access hole of the abutment to protect the hex head of the screw. Packing retraction cord in to the sulcus before cementation might make cement cleanup easier and less tedious. Cement the restoration with restoration material (PFM: 3MEspe RelyX, Procera®: 3MEspe RelyX, Lava: 3MEspe RelyX, e.max®: Multilink®Ivoclar, empress: Multilink®Ivoclar) recommended temporary or permanent cement.