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Elvio Durando

Elvio Durando DDS,Master in oral rehabilitation by the National University of La Plata-Argentin. Fellow in Oral Implantology, University of Pittsburgh. Director of Ateneo de Implantologia Oral

Healing Abutment Rescue (Part 1)

11702 Views - Apr 2017

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There are several cirucmstances where we cannot dispose of specifical prosthetic components to solve rehabilitation cases with dental implants, or that the componest that we have at our disposal do not fit our needs to obtain an optimal emergency pofile. Some of these situations among other could be:

First: In the exposure implant surgery stage we do not have the specifical healing abutment which corresponds to the connection of tht implant.

Second: We have the corresponding healing abutment but the diameter or height is less than needed.

Third: When we want to obtain a certain emergency profile that will fit the tooth to be restored and how to develop the personalized healing abutments.

Part 1

When receiving patients that had been treated with dental implants by other clinicians, is possible that the patient does not have the specific documentation and description of the inseted implant, and that radigraphically we cannot distinguish the brand, model and connection of the submerged implant. In the case that in the implant exposure surgery, none of the healing abutments available in the office fits the implant that we need to restore, we can act in the way we are going to show in the following images:



Fig 1.- This picutre shows a model simulating the a common situation, where surgically the healing abutment is exposed.

Fig 2.- We remove the cover screw, determining in that moment the type of connection present in the implant. As we do not have healing abutments for that conection, we decided to create a healing abutment by bonding composite resins to the cover screw.

Fig 3.- The cover screw is thoroughly washed, decontaminated and ready to be prepared for the adhesive procedure.

Fig 4.- Over the external surface a 50 micron Aluminium Oxyde sand blast is applied until we achieve a homogeneous opaque surface. The surface will be washed with water spray and dried with air.

Fig 5.- We will apply an hydrophobic bonding over the treated titanium surface and thinned with air in order to avoid excess.

Fig 6.- We will prepare the body of the screwdriver by lubricating it with vaseline, creating a thin layer that will impede the composite to stick to the metal.

Fig 7.- The screwdriver is inserted firmly in the cavity of the cover screw.

Fig 8.- With a syringhe tip, we will aplly a small quantity of flowable resin, wetting very well the previosly treated surface of the cover scre and embracing the body of the screw driver tip.

Fig 9.- Polymerization, it is recomemnded to spin slowly the ensemble to polymerize all the way around.

Fig 10.- With a metallic instrument and silicon tips, we will apply the composite paste, shaping the future healing abutment with the desired diameter and height needed for the clinical case.

Fig 11.- We polymerize again, this time a long 60 second polymerization, achieving a complete hardening of the resin. TIP: Holding the screw by the threads with a tweezer, doing a traction movement we can separate the screw driver form the modified screw.

Fig 12.- Now is time to finish and polish the new abutment, with abrasive discs, abrasive rubbers, and brushes to give the final shape, polishing and luster. Surface shining is necessary to facilitate the higyene and avoid plaque retention.

Fig 13.- To the left of the image we can see a healing abutment produced in titanium industrially by the company, and to the right the modified healing abutment using our technique.

Fig 14.- By sterilizing the healing abutment, we can immediately place it in the wound to star the healing stage. TIP: Take into account that when introducing the screwdriver we should make it snap in the bottom of the titanium in order to avoid breakage of the modification that can happen by twisting the scredriver on the resin..

Conclusions

Here is just one option to solve a case in a situation that can occur; with these elements available in almost any office that performs implant rehabilitation, without using the required components of the manufacturer that were unavailable at that time.
 

Bibliography

  1. Restauraciones Protéticas Adhesivas, Roberto Chaves, Ediciones Advance, 1991.
  2. Complicaciones biológicas y complicaciones relacionadas con el material en Implantologia Oral. ITI Treatment Guide, Volumen 8. pag 116/119. U. Bragger, L.J.A. Heitz-Mayfield. Editorial Quintessence, 2015.
  3. Técnicas de exposición en Implantologia Oral. Martin Stagl et al. Quintessence Internacional,14/20
  4. Vol 1, Num 1, 2013.
  5. La rehabilitación Implanto Protésica, Pedro Gazzotti, Editorial Porvidence, 2008.
  6. Tissue-Integrated-Prostheses, Branemark/Zarb/Albrekstsson, Quintessence Books, 1985.
  7. Esthetic Implant Dentistry, Cap 8 159/202. Patrick Palacci, Quintessence Books, 2001.
  8. Prótesis dental sobre Implantes. Carl E. Misch, Editorial Elsevier, 2006.

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