Written by Allen L. Schneider, DDS, FAGD, DICOI, and Gregori M. Kurtzman, DDS, MAGD, FPFA, DICOI Thursday, 30 September 2004 19:00
Single-stage implants are being utilized more frequently. Currently, Straumann ITI, Lifecore Biomedical, Sulzer Paragon, and 3I offer an implant designed to be used in a single stage with a flared crestal architecture that accepts a solid abutment. Traditional-type implants, whether internal or external platform, typically have the restoration contacting only the abutment head. Restorations fabricated for single-stage type implants have a margin that contacts the implant platform and a central core that is the solid abutment.1 The implant companies manufacturing single-stage implants have developed plastic impression caps that engage the abutment and seat on the implant platform.2
|Figure 1. Solid abutments are placed into the single-stage implants.||Figure 2. Completed full-arch impression demonstrating details of the margin area of the implants.|
|Figure 3. Cast fabricated from the full-arch impression.||Figure 4. Lateral view of the cast fabricated from the full-arch impression.|
|Figure 5. Cast copings fabricated on the ditched dies.||Figure 6. Cast coping on an analog to verify marginal fit.|
|Figure 7. Porcelain application on the metal coping verified on an analog.||Figure 8. Completed porcelain-fused-to-metal crowns seated on the implants.|
|Figure 9. Radiograph demonstrating marginal fit of the porcelain-fused-to-metal restorations.|
Following the appropriate healing period, the healing screw is removed from the single-stage implant. A solid abutment is threaded into the implant (Figure 1). Modification to the solid abutment can be made to the height or circumferential geometry to accommodate the space restrictions for fixed prosthetics.3,4
The restorative phase for single-unit implants can be divided into 3 components: impression fabrication, temporization, and final restoration insertion. The majority of the time involved chairside can be in the temporization component.
|Figure 10. Acrylic coping fabricated on an analog to duplicate the margins of the single-stage implant.||Figure 11. Acrylic coping tried on the single-stage implant intraorally to verify fit.|
|Figure 12. DirectCrown temporary tried in intraorally over the acrylic coping to verify clearance circumferentially.||Figure 13. DirectCrown temporary filled with self-polymerizing acrylic inserted over the acrylic coping intraorally to develop proximal contacts.|
|Figure 14. Temporary crown upon removal intraorally.||Figure 15. Acrylic flash has been removed and gross shaping has been performed. The margin is indicated in red pencil.|
|Figure 16. Completed temporary showing margin detail.||Figure 17. Buccal view of the completed temporary.|
|Figure 18. The completed temporary placed intraorally.|
The Straumann ITI implant and Lifecore Stage 1 implant provide 3 solid abutments that vary from 4, 5.5, and 7 mm in height.15 This allows selection of a solid abutment to accommodate the available interarch space. These abutments may be modified when needed if the available sizes are not adequate.9 If a height less than 4 mm is required, selection of a screw-retained prosthesis should be considered in lieu of a cement-retained restoration.
Complexity of restoring dental implants may hamper dentists from adding implant treatment modalities to their armamentarium. Simplifying the restorative portion of treatment for fixed prosthetics via incorporating common techniques used daily for crown and bridge will allow more general practitioners to restore implants in their practices.
- Kaiser DA, Jones JD. New impression system for ITI solid abutment cementable restoration. J Prosthet Dent. 2000;83:276-278.
- Ivanhoe JR, Adrian ED, Krantz WA, et al. An impression technique for osseointegrated implants. J Prosthet Dent. 1991;66:410-411.
- Sheridan P, Koka S. Complete seating of an implant impression coping. J Prosthet Dent. 1995;73:322-324.
- Clepper DP. Implant-level transfer impressions. Dent Today. Jul 1999;18:70-73.
- Jones JD, Kaiser DA. A new gingival retraction impression system for a one-stage root-form implant. J Prosthet Dent. 1998;80:371-373.
- Names CD. A new implant impression technique for prosthodontic accuracy. Dent Implantol Update. 1993;4:42-44.
- Chung WC. An improved impression technique for implants. Quintessence Int. 1995;26:545-547.
- Charters R. Laboratory fabrication of a single crown on the non-modified solid abutment of the ITI Dental Implant System. J Dent Technol. 2000;17:18-21.
- Charters RT. Restoration of a modified solid abutment of the ITI dental implant system: one of the most unique systems in implant dentistry. J Dent Technol. 2001;18:10-12.
- Perel ML. Progressive prosthetic transference for root form implants. Implant Dent. 1994;3:42-46.
- Misch CE, Bidez MW. Implant-protected occlusion: a biomechanical rationale. Compendium. 1994;15:1330-1334.
- Misch CE, Bides MW. Implant-protected occlusion. Int J Dent Symp. 1994;2:32-37.
- Misch CE. Progressive loading of bone with implant prostheses. J Dent Symp. 1993;1:50-53.
- Rieger MR. Dental implant loading. J Gt Houst Dent Soc. 1995;66:7-8.
- Higginbottom FL. Restoration of the single stage non-submerged dental implant. J Calif Dent Assoc. 1995;23:65-70.
- Federick DR. Methods and materials for provisionalization in implant prosthodontics. Part I. Dent Implantol Update. 1995;6:85-87.
- Federick DR. Methods and materials for provisionalization in implant prosthodontics. Part II. Dent Implantol Update. 1995;6:92-95.
- Biggs WF. Placement of a custom implant provisional restoration at the second-stage surgery for improved gingival management: a clinical report. J Prosthet Dent. 1996;75:231-233.
- Chee WW. Provisional restorations in soft tissue management around dental implants. Periodontol 2000. 2001;27:139-147.
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