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Clinical Tip:
Modifying Inclusive Custom Temporary Abutments

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bockhorst 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).

Add temporary acrylic to the crown (Fig. 8).

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 inclusivemagazine@glidewelldental.com.

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