Implant Restoration Step-By-Step Guide
Below are the steps to be taken from implant placement by the Grad Perio/GPR Department to a final implant crown restoration.
- When the resident who placed your implant evaluates it and deems it restorable, they will contact you to give you the go-ahead.
- Work with your restorative/pros faculty and Dr. Dan Wilson to make sure you order the correct implant analog and impression copings (see Implants, Ordering Parts for more information). Dr. Wilson will give you an estimated arrival date for your parts (usually 5-7 business days) and will email you when they have arrived.
- Fabricate your custom impression tray.
- Schedule your patient. You can either schedule them based on the estimated arrival of your parts, or to be safe, after you have received them. However, it is **important that you have your parts before you see them**.
- Implant kit (either universal or implant system specific -- e.g. Straumann)
- Basic Cassette
- Impression Material -- light and heavy body PVS + adhesive
- Custom Impression Tray
- Impression Copings
- Implant Analog
- Paridex/Chlorhexidine mouth rinse
- Monoject Syringe
- Using the implant kit, remove the healing abutment. This can usually be done manually, but may require you to use the torque wrench provided in the implant kit. **Lefty Loosy, Righty Tighty**
- Irrigate the inside of the implant with Chlorhexidine using a Monoject Syringe.
- Place the impression coping and lightly hand-tighten.
- Make the impression according to the technique that matches the impression copings you ordered (closed vs. open tray).
- Disinfect the impression and attach the implant analog to the impression coping.
- Replace the healing cap and dismiss your patient.
Pouring the Impression
Regardless of whether you took and open or closed tray impression, you should now have an impression of the arch that the implant was placed in with the impression coping inside and the implant analog attached. Use the following steps to pour the impression and get it ready to send to the lab for crown fabrication:
- GI-Mask Universal Separator
- GI-Mask Gingival Mask material
- WhipMix Vacuum Mixer
- ResinRock stone
- Dry the impression.
- Spray a light, but complete, layer of GI-Mask Universal Separator onto the impression material immediately surrounding the implant (this will help the GI-Mask Gingival Mask material not to stick to the impression).
- Inject GI-Mask Gingival Mask material into the impression immediately surrounding the implant to simulate gingival tissue. You may use a wet cotton swab to help shape the material, if desired.
- After the GI-Mask Gingival Mask material has set up, pour up the impression as you normally would for any impression using your WhipMix Vacuum Mixer and Resin Rock stone.
- After the stone has set up, separate the impression from the cast.
- If desired, and under your covering faculty's direction, you may reshape the gingival simulation material using an acrylic bur to give the lab more room to create a better emergence profile of your crown.
After you have poured your cast, the next step is to send it to the lab for crown fabrication. Use the following step to do so:
- Bring your poured cast to your covering faculty to select the appropriate abutment and whether or not the crown should be cement or screw retained.
- Based on the recommendation of your faculty, order the appropriate abutment using the same Implant Order Form as before and place it in Dr. Wilson's box.
- After the abutments are in, you can now send the newly poured cast + the opposing cast (both mounted) + the abutments to the lab for crown fabrication.
Seating the Crown
The procedure of seating the crown will depend on whether or not your crown is cement or screw retained. Regardless of how it is restored, make sure that the occlusion is such that the adjacent teeth are able to hold shimstock, but the implant crown drags shimstock. This is because implants do not have a PDL, but the surrounding teeth do. If the implant crown is at the same level of occlusion as the natural teeth adjacent to it, the implant will end up taking too much force, which could cause it to fail.
Also, be sure to not over-torque the implant. See the Implant Torque Guide below for manufacturer guidelines on the amount of torque for each implant system.
Additional Resources: Implant Torque Guide