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