Prefabricated implant abutments don't require CAD/CAM or other special equipment and the components are readily available, allowing practitioners to buy and send them to the laboratory along with the case. Nelson Rego, CDT, AAACD, offers a step-by-step look at using a Straumann® Anatomic IPS e.max pre-fabricated abutment.
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Step 1: A 29-year-old man presented with a failing root canal tooth; the previous crown and post were missing. The patient requested another crown, but the radiograph indicated the presence of a root fracture, thereby necessitating tooth extraction.
Step 2:When given the option of a bridge or implant, the patient selected an implant, which was immediately placed. Due to the patient’s exceptional bone quality, the dental team also decided to immediately load a temporary restoration. To ensure the design of the temporary restoration was ideal, Nelson Rego fabricated a waxup. Dr. Ken Hovden placed a prefabricated temporary abutment in the patient’s mouth and then filled the matrix that was created from the waxup with bis-acrylic temporary material. This matrix was then seated in the mouth to create a screw-retained custom temporary. This allowed the patient to “test-drive” the restoration and discuss any features that required modification, and enabled Dr. Hovden to develop the implant gingival architecture immediately upon implant placement.
Step 4: Rego measured the soft tissue and, since this is a bone-level implant, chose a Straumann Anatomic IPS e.max abutment with a 3.5-mm gingival cuff height (a 2.0mm gingival cuff height is also available). A cuff height of 3mm or more is often required for placing the margins near the gum line on bone-level implants. Therefore, a 3.5mm abutment equates to a 4.5mm depth for the bone-level implant, with it still being “in the zone.” It’s important to keep the implant abutment margins approximately 1mm subgingival in order to facilitate cement clean up.
Rego tried the Straumann IPS e.max abutment on the soft tissue model; this is a secondary soft tissue impression.
Step 6: On the working model, Rego carefully prepared a prefabricated 3.5mm Straumann Anatomic IPS e.max abutment using a high-speed handpiece and copious amounts of water.
Step 7: He placed the abutment on the working model, fabricated a full-contour waxup, scanned it using the Straumann CAD/CAM Scanner and ordered a high-translucency IPS e.max CAD crown in shade B1 from the Straumann milling center.
Step 8: IPS e.max CAD is lithium disilicate glass ceramic in a soft state that can be milled and, at this stage, exhibits an unusual bluish color. Upon receiving the restoration from the Straumann milling center, Rego carefully fit it on the model and cut back the blue material to create the room necessary for the incisal porcelain.
Step 10: The IPS e.max CAD framework after crystallization; note the esthetic optical properties of the material.
Step 11: Rego added IPS e.max ceram gingival and incisal porcelains to mimic the patient’s natural dentition and then fired it.
Step 14: The final restoration is functional as well as esthetically pleasing to both Dr. Hovden and the patient.
Nelson Rego, CDT, CoOwns and operates Smile Designs by Rego in Santa Fe Springs, CA, with his brother, Juan. An Accredited Member of the American Academy of Cosmetic Dentistry, Rego has published over...See more