Single or Multiple Units

The purpose of the fixture level impression is to accurately relate the position of the implant fixture in the mouth to a working laboratory model.

Upon receiving clearance from the surgeon to begin the restorative process, be sure to obtain the necessary information regarding number of implants placed, implant type and fixture size. Next, call the Implant team at Dental Designs with the aforementioned implant information for consultation on the necessary components and proper instruments to achieve an accurate impression. Finally, call the patient to set up a 1 hour appointment to take impressions.

Component Checklist for Implant Impression Appointment:

• impression coping (one per implant)
• proper screwdriver (*an additional tool is required for removal of temporary abutments if present)
• full arch plastic trays for upper and lower arches
• conventional crown and bridge impression material (NO alginate or hydrocolloid on implant arch)
• bite registration may be required on free-end or in cases of unusual
• occlusal scheme.

Step-by-Step:

1. Remove the healing abutment or cap using the appropriate screwdriver.
2. Insert the impression coping immediately after removal of the healing abutment to prevent tissue collapse.
3. Verify that the impression coping is fully seated with a Radiograph.
4. Obtain a full arch plastic tray (stock or custom) for the impression. Try in the tray to verify that there is no contact with the coping.
5. Using a medium or heavy body impression material, syringe around the impression coping and into the tray. Allow time for the material to set and remove the tray. (impression coping will remain connected to the implant.)
6. Remove the impression coping and immediately replace the healing abutment.
7. Take an impression of the opposing arch (it is okay to use alginate if pouring yourself or delivering to the lab in the appropriate time).
8. Take a bite in cases of unusual occlusal scheme or free-end.
9. Take a shade.
10. Pack all parts and send to Dental Designs (*include same impression coping used to take the impression)

Prescription:
*Include the name of the surgeon and the type and size of the implants
*List the desired restoration type as discussed with the patient
*Shade
*Include a copy of the Radiograph with the impression coping in place
*Call Dental Designs when scheduling patient to confirm appointment

Instruments Needed:

• Screwdriver (specific to implant type), used to remove the healing cap/abutment and seat the final abutment.
• Insertion Guide, fabricated by Dental
• Designs for seating all titanium abutments.
• Torque Driver

Step-by-Step:

1. Remove the healing cap or abutment using the appropriate screwdriver.
2. Deliver the abutment inside the insertion guide to the implant fixture in the mouth. (If unable to seat multiple abutments using the seating guide, seat them individually using the guide)
3. Insert the screw through the opening of the insertion guide.
4. Hand tighten the screw with appropriate screwdriver. (DO NOT torque yet)
5. Remove the insertion guide. (Should pop right out)
6. Take a Radiograph to verify that the abutment is completely seated into the implant fixture.
7. Insert the crown on top of the abutment. [For Metal Try-in, Stop here and disregard #8-10]
8. Check contacts and occlusion.
9. Torque the Abutment using the appropriate torque level. (specific to implant type and size) [See Torque Driver instruction below]
10. Cement the Crown onto the abutment and clear away excess. [See Cementation instructions]

Using the Torque Wrench:

The DynaTorq Torque Wrench is designed to tighten abutments and fasten screws to a defined torque. Proper use of a torque wrench is critical.

1. Select the proper torque wrench based on the recommended torque values of the implant system used, and insert the correct driver insert (also specific to the implant system) into the wrench head.
2. Engage the driver with the implant abutment screw (be sure the driver is fully engaged in the screw or stripping could occur).
3. Place a finger on the head of the torque wrench. Follow the direction of the arrow (clockwise) and tighten.
4. The wrench’s torque limit will break at a pre-set level (labeled on the handle in NCM). The proper torque limit has been applied when the head of the wrench breaks away from the handle. Do NOT tighten further as additional torque may strip or break the abutment or screw.

*When finished Please clean the torque wrench and driver insert with a disinfectant wipe, rinse under warm tap water, wipe dry (Do NOT place in ultrasonic) and then Autoclave.

• Dental Designs uses state of the art scanning and milling for denture bars. NobelProcera® bars set new standards. They are individually designed using 3D prosthetic driven software, industrially milled from a solid biocompatible monobloc of titanium. Thanks to precision milling, these bars exhibit exceptional fit, ideal load transfer and long-term stable screw joints.

  Appointment protocol:

  • Primary impression to fabricate custom tray allowing for implant transfers
  • Final impression either to fixture level or after addition of multi-unit abutments
  • Bite registration with bases stabilized by addition of a screw to one or two implants
  • Tooth arrangement try-in to confirm bite registration, esthetics and function
  • Metal bar try-in to verify passive connection
  • Optional: Wax try-in with teeth and the bar together

  Final seating appointment

  In-Lab days needed:

  • custom tray 3-4 days
  • bases and rims 3-4 days
  • tooth arrangement 4-5 days
  • CAD/CAM Titanium Bar -depending on the system 10-15 days
  • Re-wax teeth over bar for additional try-in 4-5 days
  • Process and polish, ready for seating 6-7 days

Diagnosis Questions:
1. Does the color of the impression coping match that of the healing cap?

If not, then a new impression coping is needed. If yes, the color matches, but it won’t fit.

2. Is there any soft tissue and/or bone over grown across the implant?
If yes, then either you or the surgeon will need to remove it. If it is bone then most likely the surgeon will need to remove it.

3. Are the adjacent teeth impeding the insertion of the impression coping?
If yes, then you can;
1) Grind on the adjacent tooth or
2) Grind on the impression coping to get it to fit. Just make sure you make us aware that you have done so on the RX.

1. Is the abutment seated all the way?
If yes;
2. Are the contacts too heavy?
If yes, then lighten the contacts If no;
3. Is the tissue blanching and pushing back the crown?
If yes, have the patient bite on a cotton roll.

1. Is the abutment seated all the way?
If yes then:
a) Either the occlusion was not ground in properly,
b) The crown has been improperly mounted,
c) The bite is off.

1. Are the abutments down all the way?
If yes, then refer to troubleshooting seating problems for the crown. If no, then refer to abutment seating problems. If all abutments are seated and problems with contacts and tissue have been addressed, then either
a) The lab did not get impression poured properly.
b) Impression was not taken properly.

NOTE: If you are seating multiple abutments for a bridge and lose orientation, always refer back to the model you can see how it should look.

Solution: It can be cut away and destroyed.

Solution: 1. Make sure you have the right screw driver for the implant.
2. Make sure the access hole of the abutment is free of debris.
3. Make sure the screw driver is long enough.

Solution: Make sure the screw is not stripped. Another possibility is that the torque wrench could be broken. Refer to the section on how to properly use a torque wrench.

Solution: You can use a torque wrench to back them out.

Solution: Perhaps there is not enough retention on the abutment. Re-cement and check to see if lateral and occlusial forces are light. If temporary cement was used, you may switch to a permanent cement, but be aware that the crown will have to be cut off should the abutment ever need to be removed.

Solution: Make sure it is torquing properly. You could try replacing the screw with a newer screw. If the screw still comes loose it may be a sign that there is something wrong with the actual implant itself.