DELIVER SCREW RETAINED RESTORATION
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
restoration on the working model. Check contacts, shade and overall
design and finish. Ensure screws pass through the screw access channel of
the restoration without binding.

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. 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 intermediate abutments are usually the same as for
standard abutments but the final screw fixing the restoration to the

Intermediary abutment
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 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.

Confirmed seat
Adjust proximal contacts as needed. Install the final restoration and hand
tighten the final screw with the driver.
If the crown appears to seat some degrees rotated, unscrew the
final screw and rotate the restoration in to the correct position. Depending on the
brand of implant, the crown can have 3, 4, 6, or 8 positions. Re hand tighten
the final screw and take an x-ray to confirm proper seating of the
crown.
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.
Torque the screw with the torque driver to recommended torque.
Wait a few minutes and torque the screw again to specs. Place a
cotton ball in to the screw access hole of the crown to protect
the hex head of the screw and fill the screw access channel with
composite.