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14 | cerecdoctors.com | quarter 3 | 2013
subcrestal to the buccal crest (Fig. 11).
Cortical-cancellous bone particulate is
thenplaced in the gapbetween the buccal
bone and implant. A great advantage
of the Omnicam is the ability to image
directly over a surgical site since there
is no powder. A temporary abutment is
then placed and imaged for temporary
fabrication (Fig. 12). In this case, I used
a custom abutment. The margin is hard
to see if the implant is subgingival, so the
crown is designed to engage the abut-
ment where there is anti-rotation to
allow indexing of the restoration on the
abutment. The restoration is designed
out of occlusion and with a hole over the
abutment screw access hole (Fig. 13). By
using virtual articulation function in the
new 4.2 software, the excursive move-
ments can be eliminated prior to place-
ment in the mouth. The restoration is
then milled and fit over the stock abut-
ment outside the mouth. Composite is
then added to refine margin and emer-
gence profile (Fig. 14).
Once the screw-retained temporary
is ready, it is placed on the implant and
torqued to 15ncm (Fig. 15). The access
is then packed with Teflon tape and
composite cured to the level of the
occlusal table. Once the temporary
crown is in place, all occlusion and
excusive movements are verified. The
temporary allows for maintenance of the
papillae and creation of the proper emer-
gence profile for the final prosthetic.
The patient is instructed to not eat on
that side until we get the final prosthesis
placed. Regular brushing and flossing is
recommended. The patient is prescribed
antibiotic therapy and Peridex rinse for
two weeks. The patient comes back for
a quick appointment after two weeks for
a post-operative check. The implant is
then allowed time to integrate.
After three months, the patient comes
back in for the scanning of the TiBase
for the final restoration. Note the tissue
support and emergence profile of the
| | | O ’ B rya n
Fig. 11: Final implant placement
Fig. 12: Temporary abutment
Fig. 13: Temporary abutment and
provisional design
Fig. 14: Refined provisional
Fig. 15: Radiograph of provisional
Fig. 16: Provisional in place
Fig. 17: TiBase placed
Fig. 18: Scanbody placed
Fig. 19: Model box step
Fig. 20: 3-D model Scanbody
Fig. 21: Model trimmed
Fig. 22: Abutment margin
Fig. 23: Restoration axis
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