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.