Presentation Category
Implant Dentistry
Introduction/Context/Diagnosis
Buccally placed tissue-level implants in the esthetic zone may encounter various challenges, particularly concerning the trajectory of the screw channel and the implant body's placement. In this case, while addressing an edentulous space in the upper left quadrant with an implant bridge spanning from #12 to #14 it became evident that #12 was far too buccally placed. To address this issue, #14 was designed for screw retention, while #12 was planned for cement retention to accommodate the screw channel exiting through the buccal cusp. Although this method may seem to make the cement retained aspect of the restoration unretrievable, using a temporary cement, such as Tempbond, ensures that the restoration is cemented and sealed while also making it retrievable once the screw is loosened from the other abutment. Complicating matters more, the tissue-level implant placement at #12 caused the implant body to be visible beneath the crown margin. Despite several delivery attempts, it became evident that a customized approach was necessary. The decision was made to prep the implant body and abutment with a crown bur to establish a custom crown margin and to section #12 from the bridge. Ultimately, the restoration was modified into a single-unit crown on #12; and #14 incorporating a mesial cantilever. This allowed for individual adjustment of #12 and ensured complete seating of the crown independent from the insertion of #14. This case would not have been delivered nor successful without the assistance of Dr. Sadowsky and Carlos. Dr. Sadowsky’s research and innovative ideas regarding prepping the implant body and separating of the bridge into two separate units set this case up for success; and without Carlos’ work in sectioning the bridge and a mid-appointment shade change, delivery would have been prolonged one extra appointment.
Location
Arthur A Dugoni School of Dentistry, 155 5th St, San Francisco, CA 94103, USA
Format
Presentation
Attempting Heroics: Restoring Buccally Angulated Implants
Arthur A Dugoni School of Dentistry, 155 5th St, San Francisco, CA 94103, USA
Buccally placed tissue-level implants in the esthetic zone may encounter various challenges, particularly concerning the trajectory of the screw channel and the implant body's placement. In this case, while addressing an edentulous space in the upper left quadrant with an implant bridge spanning from #12 to #14 it became evident that #12 was far too buccally placed. To address this issue, #14 was designed for screw retention, while #12 was planned for cement retention to accommodate the screw channel exiting through the buccal cusp. Although this method may seem to make the cement retained aspect of the restoration unretrievable, using a temporary cement, such as Tempbond, ensures that the restoration is cemented and sealed while also making it retrievable once the screw is loosened from the other abutment. Complicating matters more, the tissue-level implant placement at #12 caused the implant body to be visible beneath the crown margin. Despite several delivery attempts, it became evident that a customized approach was necessary. The decision was made to prep the implant body and abutment with a crown bur to establish a custom crown margin and to section #12 from the bridge. Ultimately, the restoration was modified into a single-unit crown on #12; and #14 incorporating a mesial cantilever. This allowed for individual adjustment of #12 and ensured complete seating of the crown independent from the insertion of #14. This case would not have been delivered nor successful without the assistance of Dr. Sadowsky and Carlos. Dr. Sadowsky’s research and innovative ideas regarding prepping the implant body and separating of the bridge into two separate units set this case up for success; and without Carlos’ work in sectioning the bridge and a mid-appointment shade change, delivery would have been prolonged one extra appointment.
Comments/Acknowledgements
Presentation Category: Implant Dentistry