DELIVER PIB

Subfame assembled

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 the subframe on the working model using only one screw in a terminal implant. Hand tighten the screw and examine if the subframe seats passively on all implants with just one screw tightened. Ensure all screws pass through the access channels without binding.

Torque wrench

Determine appropriate torque requirements for the final screws. Some implant manufacturers have different torque specifications depending on the implant diameter. In case the restoration is a large span bridge, intermediate abutments (abutment for screw by Biohorizons, multi unit abutment by Nobel Biocare™, standard abutment by Biomet 3i™ a.o.) may be already in place or need to be placed before the restoration is seated. Torque requirements for the

Intermediary    abutment

intermediate abutments are usually the same as for standard abutments but the final screw fixing the restoration to the intermediate abutments is usually much lower (10Ncm to 15Ncm). 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 implants is planned. Remove any temporary restorations, temporary abutments or trans mucosal healing abutments. Irrigate the inside of the implant with chlorhexidine and flush out any debris.

Place the subframe in the patients mouth on to the implants, using only one screw in a terminal implant. Hand tighten the screw and examine if the restoration seats passively on all implants with just one screw tightened. After passive fit of the restoration is confirmed in the patients mouth, hand tighten the remaining screws. Take a panograph to ensure all components are seated and as a bone level baseline record. Torque all screws with the torque wrench to implant manufacturers specification. Wait a few minutes and torque the screws again to specification. Place a small cotton ball in to each screw access channel to protect the hex of the screw and fill the access channel with composite. Cement the individual crowns on to their respective simulated preps. Adjust the occlusion and equalize lateral contacts.