DELIVER CEMENTABLE RESTORATION

Seating index

Inventory all parts received from the laboratory immediately after arrival of the case in the office. Are the correct number of final screws included and are they in the original packaging? Assemble all parts and the restoration on the working model. Check contacts, shade, margins and overall design and finish. Ensure screws pass through the abutments without binding. To help orient the abutment in to the correct position, the laboratory can supply a seating index that transfers the abutment position from the model to the patient or mark the facial of the abutments with a Sharpie marker.

Torque wrench

Determine appropriate torque requirements for the final screws. Some implant manufacturers have different torque specifications depending on the implant diameter or abutment material. Have torque wrench with appropriate driver tip on hand. Laboratories often offer torque wrenches for a nominal rental fee or contact your local implant manufacturers account representative. Familiarize yourself with the torque wrench, torque settings and how it works.

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: 3M™Espe™ RelyX™, Procera®: 3M™Espe™ RelyX™, Lava™: 3M™Espe™ RelyX™, e.max®: Multilink®Ivoclar, empress: Multilink®Ivoclar) recommended temporary or permanent cement.