TREATMENT

The mandibular left 1st molar, tooth #19, was extracted and the chronic inflammatory tissue was debrided from within the socket with rotary instruments and curets. The socket was grafted with a bone graft material and covered with a membrane. The proposed implant site was allowed to heal for 8 weeks. A 5mm diameter x 13mm length Certain® PREVAIL® (internally interfaced) Implant with a 5.8mm diameter implant collar and Full OSSEOTITE® Surface, was placed using a singlestage protocol. Next, an Analog Placement Index was made to eliminate the need for an implant level impression by the restorative dentist. The index was made by syringing an elastomeric impression material i.e., Impregum™ (3M ESPE, St. Paul, MN) around a 5mm OSSEOTITE Certain Implant Impression Coping and at least one tooth mesial and distal to the implant (Figure 3). After the index was made, an Encode® Healing Abutment 5mm(D) x 6mm(H) with a 6mm Emergence Profile flare was placed with a Large Hex Driver and the soft tissues were closed using intermittent sutures (Figure 4).

CLINICAL TIP: The Analog Placement Index must record the detailed occlusal anatomy of at least one tooth mesial and one tooth distal to the implant impression coping. The tooth surfaces must be dry. The index can be made using a rigid elastomeric impression material or bite registration material.

NOTE: Encode Healing Abutments are designed with the same dimensions of the Emergence Profile System used with 3i’s one piece healing abutments. The Encode Healing Abutments are available in 2, 3, 4, 6 and 8mm collar heights. The difference is that Encode Healing Abutments have codes imbedded on the occlusal surface. These codes enable the computer to identify the hex position, the collar height for implant placement depth and the restorative platform diameter. The appropriate sized healing abutment is determined by the highest point of the soft tissue above the implant (generally interproximal), so there is a minimum of 1mm of abutment collar visible around the entire healing abutment.

Fabrication Of Master Cast

The original diagnostic cast was modified in the laboratory by removing the dental stone in the area of the mandibular left first molar. A 5mm Certain Laboratory Analog was attached to the pick-up implant impression coping in the Analog Placement Index. Sufficient stone was removed from the cast with a large acrylic bur to create a buccal window for implant placement and provided visual access during the luting process. The Analog Placement Index was aligned onto the occlusal surfaces of the cast so that no part of the implant analog touched any part of the cast. Autopolymerizing acrylic resin was used in a bead brush technique to lute the analog to the cast (Figure 5). Alternatively, autopolymerizing acrylic resin or dental stone can be mixed and loaded into a syringe for injecting the material around the analog.