Blog Author: Robert Lang
Got a new patient and he said he was ready for his implant crown. The implant was placed a out a year ago. it is so challenging to restore poorly placed implants and tales so much more time to get compromised results when there is poor planning.
the implant was too distal and too palatal. That made it more work then this should be. Just a tough case and the position compromised the final result.
This patient presented with #30 crown fractured off with recurrent decay and the tooth could not be saved. We discussed treatment options, he watched our implant videos on treatment options and possible implant treatment. He elected to have an implant placed. After taking the scan and doing the digital waxup it appeared that we could remove the tooth and place the implant immediately. The roots were short and there was adequate bone. I informed the patient that this was possible if all aspects of the procedure went perfectly, ie if the planets align. If not we would remove the tooth and graft the site and wait. I also did a custom healing abutment which I love in this situation as no sutures were required and it helped keep my graft in place, and started shaping the tissue immediately.
This was a motivated compliant patient that I got very good fixation of the implant. It is not often I do molar immediates but felt this was a very good indication.
This case the patient needed his remaining teeth removed and upper and lower immediate dentures. Tx options were discussed and he elected for lower implant retained overdenture. After a CT was taken immediate implants were discussed. At the surgical date it would be determined if immediates could be placed. He was told if everything went well the implants would be placed at the time of extraction. Tissue level Biohorizons were placed freehand. He is planning to do the uppers at a future date.
Just another case with another custom healing abutment. It is aour standard protocol now in most cases. I am doing a presentation this week so I figured I would post this. The final crown was made from the initial scan at the time of surgery. I literally removed the healing abutment and placed the crown. Also the bone was profiled at the time of surgery
Comparison of the gingival 1/3 of the custom healing abutment and final crown
I have been doing all my single stage surgeries with custom healing abutments since Enamic became available. It has been a learning process and took some time to incorporate the digital workflow for the implant procedure. It takes us about 30 minute longer but saves more time from final Imaging. For posterior teeth I can make the final crown from the initial impression. For anteriors you have to evaluate to see if you need to re image. I posted this for discussion, I love this workflow. This custom healing abutment and crown had an emergence profile that I felt was too broad. Love to hear how others would shape the gingival portion.
Did this case today, Extracted #8, immediate implant placement with grafting and custom healing abutment. I really am enjoying this work flow. The final crown is ready to mill from my Omnicam Image today.
It takes about 18 min to mill Enamic and another 10 or so to cement it to Tibase. In this case I was doing implants and grafting on the lower left as this was done.