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Bradley C. Bockhorst, DMD
Temporizing implants can provide multiple benefits, including managing the soft
tissues, preventing the adjacent teeth from shifting, and providing the prosthetic
prototype for the final restorations. The custom temporary abutment and
BioTemps® provisional crown packaged with the Inclusive® Tooth Replacement System are fabricated presurgically and will most likely need to be adjusted at
the time of delivery.
Each Inclusive custom temporary abutment is precision-milled from
specifically compounded, medical-grade polyether ether ketone (PEEK), a
thermoplastic material with excellent mechanical and chemical resistance
properties. This advanced biomaterial is used in medical implants and
has a proven long-term track record in dental implantology. These
temporary abutments can easily be adjusted and polished chairside.
BioTemps crowns are milled from poly(methyl methacrylate) (PMMA)
and should be relined with a compatible material (i.e., cold-cured
MMA, Jet Acrylic [Lang™ Dental; Wheeling, Ill.], ColdPac [Yates Motloid;
Chicago, Ill.] or Palavit® 55 [Heraeus Kulzer; South Bend, Ind.]). Other
reline materials such as composites and ethyl methacrylate will only
semi-chemically bond to the BioTemps material.
Note: Roughening up the surface or creating grooves in the abutment with a diamond bur or disc will create a mechanical retention. This would be done after the crown is relined, prior to cementation.
Adjusting the Inclusive Custom Temporary Abutment
Place the temporary abutment on
the implant and tighten the abutment
screw (Fig. 1).
Seat the BioTemps crown on the
abutment and adjust contacts as
needed (Fig. 2).
Remove the BioTemps crown, and
mark the areas on the abutment to
be adjusted (Fig. 3).
Remove the temporary abutment,
and mount it on an implant analog
for ease of handling. Use a
diamond or acrylic bur to do the
bulk reduction (Fig. 4).
Smooth and polish the abutment with a polishing wheel and bristle brush (Fig. 5).
Reseat the temporary abutment intraorally and tighten the abutment screw. Seat
the BioTemps crown to verify the adjustments. Repeat the process as needed.
Once the adjustments are completed, the BioTemps crown should be relined.
Relining the BioTemps Crown
If there is marginal fit of the BioTemps crown to the temporary abutment, the
reline can be done extraorally. Otherwise, the BioTemps crown should be relined
on the abutment in the mouth following standard procedure. In this case, the
goal was to lower the buccal margin for esthetic purposes, while leaving the
interproximal and palatal margins supragingival to facilitate hygiene and removal
of excess cement.
Roughen the surface of the BioTemps crown where temporary
acrylic will be added (Fig. 6).
Place the crown on the adjusted
temporary abutment (Fig. 7).
Adjust the crown with an acrylic bur and finish with a polishing wheel (Fig. 9).
Reglaze the crown. Palaseal®
(Heraeus Kulzer) would be a
chairside option (Fig. 10).
Delivering the Provisional Restoration
Seat the abutment on the implant, and ensure the screw is tightened to
15 Ncm (Fig. 11). Note: If the vertical height is short, you may want to "roughen
up" the coronal section of the abutment to provide additional mechanical
retention for the crown.
Seal the screw access opening
with Teflon tape (Fig. 12).
Cement the BioTemps crown
with a non-eugenol temporary
cement (Fig. 13). Important: Ensure all
excess cement is removed.
Recheck the occlusion and
schedule the patient for a
follow-up appointment (Fig. 14).
After receiving his dental degree from Washington University School of Dental Medicine, Dr. Bradley Bockhorst served as a Navy Dental Officer. Dr. Bockhorst is director of clinical technologies at Glidewell Laboratories, where he oversees Inclusive® Digital Implant Treatment Planning services and is editor-in-chief and
clinical editor of Inclusive magazine. A member of the CDA, ADA, AO, ICOI and the AAID, Dr. Bockhorst lectures internationally on an array of dental implant topics. Contact him at 800-521-0576 or firstname.lastname@example.org.