Chairside Implant Delivery – Restoration Forms the Tissue

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Chairside implant restorations are a reality.  With this reality comes the ability to truly make things customized and gain control.  This also allows us to totally screw things up as well.

In this post I wanted to share with you my techique for delivery of implant restorations.  Please note that this technique is designed for screw retained restorations and should not be used for cemented restorations.

Janice comes to our office after integration of her implant and ready for restoration.  There is compelling literature to support the concept of ‘one abutment one time’ and avoiding healing abutments (we can save that one for another post in the future).

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Our first step is to expose the implant.  We provide crestal tissue anesthesia using Lidocaine with 1:100,000 epi.  Then we make a crestal incision cheating towards the palate.

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The implant is uncovered and the digital scanning impression post is placed, verified to be seated correctly, and digitally scanned.

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The restoration is then designed, milled, placed in the oven, and extraorally glued to the tibase.

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Pushing the ‘flap’ to the buccal the implant restoration is then screwed and torqued to the implant.

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Care must be used when designing the restoration to ensure it has proper ‘critical emergence’ and ‘subcritical emergence’ (once again another topic for a future post).  If attention is not given to the design we can create more harm than good.

Also a radiograph should always be taken to ensure proper seating and that the restoration isn’t ‘choking’ the interproximal bone.

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Simply allow the tissue to heal and reform around the restoration contours.  I don’t use a stitch or anything.  Here’s what the tissue looks like approximatel 8-10 weeks later.

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Not only does the implant restoration have great emergence form, it also has a hygienic design that minimizes food impaction.  Additionally, by ‘stealing’ the great keratinized tissue from the crest and pushing it to the buccal we gain valuable keratinized tissue around the implant.

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