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Temporization<br />
Temporization utilizing the Inclusive Tooth Replacement<br />
Solution consists of seating the custom temporary abut ment,<br />
then relining and cementing the BioTemps provisional crown<br />
(Fig. 11). If a screw-retained temporary is preferred, after<br />
adjustments are made, an occlusal hole is drilled through<br />
the crown (Fig. 12). The abutment and internal surfaces are<br />
roughened up to help create mechanical retention. A guide<br />
pin is used to maintain the screw opening, and the crown is<br />
luted to the abutment with permanent cement. The crownabutment<br />
assembly is then delivered to the implant (Fig. 13),<br />
and the abutment screw is tightened to 15 Ncm (Fig. 14).<br />
The occlusal screw is covered with a piece of Teflon tape<br />
and the access opening sealed with composite (Fig. 15). The<br />
crown should be out of occlusion (Fig. 16).<br />
Figure 9: Inclusive Tooth Replacement Solution custom healing abutment<br />
Final Impressions<br />
The final impression is made with the Inclusive Tooth<br />
Replacement Solution custom impression coping (Fig. 17).<br />
The custom impression coping allows you to transfer the<br />
position of the implant as well as the soft tissue contours to<br />
the master cast. The custom impression coping is seated on<br />
the implant and the screw is tightened (Fig. 18).<br />
The access opening is sealed with soft wax to prevent<br />
impression material from flowing into the coping (Fig. 19).<br />
The closed-tray impression is made following standard<br />
technique. When the material has set, the impression is<br />
pulled. The impression coping is removed and replaced<br />
with the healing abutment or provisional restoration. The<br />
shade is selected (Fig. 20) and clinical photos are taken.<br />
A bite registration and impression of the opposing arch<br />
are made. The pre-populated Inclusive Tooth Replacement<br />
Solution lab prescription is filled out and the case sent to<br />
the lab.<br />
Figure 10: Custom healing abutment in place with access opening sealed<br />
Laboratory Fabrication<br />
Upon receipt, the lab will mount the custom impression<br />
coping on an implant analog (Fig. 21) and reseat it back<br />
into the impression (Fig. 22). A soft tissue model will be<br />
poured (Fig. 23), the case articulated, and the final restoration<br />
fabricated.<br />
Figure 11: Custom temporary abutment and BioTemps crown<br />
Based on the clinician’s preference, a cemented or screwretained<br />
prosthesis can be ordered. In this case, the<br />
cemented restoration consisted of an Inclusive ® All-Zirconia<br />
Custom Abutment (Figs. 24a, 24b) and an IPS e.max ® crown<br />
(Ivoclar Vivadent; Amherst, N.Y.) (Fig. 25). An acrylic jig is<br />
fabricated to aid in seating the abutment (Figs. 26a, 26b).<br />
Final Delivery: Cement-Retained Crown<br />
When the healing abutment or provisional restoration<br />
is removed, the soft tissues will have healed to more<br />
Figure 12: After adjustments, a hole is drilled through the crown and the<br />
crown cemented to the abutment.<br />
22<br />
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