What materials do you place inside an implant abutment or screw retained crown?

This could be a subject of an interesting post. Implants have abutments (posts) or screw retained crowns that are screwed into the implant. Invariably there is a hole where the screw is placed and tightened in order to attach them to the supporting implant.

Most dentists who are experienced with implant restorations have noticed when unscrewing a temporary implant part that the cotton pledget that was used to cover the screw is wet and often has a bad oder even when it was sealed in place with a good temporary filling. Why is this? The most likely cause is that there is no seal between the implant and the abutment or implant crown since the screw holding the restoration doesn't allow a true seal and invariably bacteria and moisture seep into the implant restoration.

Over the years I have placed many implant restorations and my technique has gradually evolved. I thought about how I might provide a more antiseptic environment inside my implant restorations. Several years ago I started using teflon plumber's tape to cover my implant screws instead of cotton. Many dentists use this material as opposed to a  small cotton pledgets that tend to wick in moisture.   and I also started using a little IRM internally to cover my teflon tape. IRM seems to be antimicrobial and tends to keep bacterial growth in check inside implant restorations as well as obturating the space adjacent to the teflon tape. Another technique employed is to use warm compacted guttapercha over the teflon tape. Both materials tend to minimize space for contaminating bacteria.  I usually do not place my composite filling into an implant crown the same day as I place my IRM since I want it to be well set prior to  placing a tooth colored composite. For abutments used with cementable crowns, I often don't bother with the composite filling at all, since leaving space for the venting of the cement internally is often desirable.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/06/what-materials-do-you-place-inside.html - http://lspindelnycdds.blogspot.com/

Comments

Post a Comment

Popular posts from this blog

Help! My Child is Terrified of the Dentist

Image
If you’re the parent of a young child, you know their brains are similar to sponges that soak up everything around them—especially in their first five years, which neuroscientists say is when they’ll do the most learning and developing in their entire life. At this formative time, your child may amaze you with what they notice: your facial expressions, the different tones of your voice, and your habits. If your habits include regular dental visits and an excellent oral hygiene routine, they’ll notice and want to emulate you. If you happen to feel anxious about your dental visits, or you groan when you’ve got to floss and brush, they may synchronize and feel your dread. This could lead to dental fears that stick with them for years—potentially a lifetime! Kids Can Be Courageous If you’re feeling guilty right now, go ahead and put that away as it won’t serve you or your little one. Everyone has some room for improvement, and Coastal Pediatric Dentistry® is here to help show you an
Read more

Going for the Gold?

Image
On the left is the older allow, on the right the new one that my lab has chosen to use The cost of a penny weight of pure gold is currently $79.53. The cost of a penny weight of pure palladium is $130.6. It used to be that palladium was added instead of gold to the precious metals often used for pfms, but now laboratories are finding that palladium is no longer affordable. The lab that I am using has just changed the formulation of the metal it's using to one that has more gold than palladium. I really do not mind, but metals with more gold are softer and often easier for a dentist to accidentally polish off delicate margins. It is important when polishing "higher gold" formulations to exert less hand pressure when performing the final polishing of the crown's margins. Other wise there should be no problem with this change. Traditionally labs have chosen alloys with higher gold percentages for optimal esthetics, since alloys with higher concentrations of
Read more

Tongue Ties: What Parents Need to Know

Image
For a long time, people just didn’t seem to know much about tongue ties. In the early years of my practice, few of my patients had ever heard of a tongue tie. When I pointed out that they or their children might be tongue tied, I was often the very first practitioner who’d mentioned it to them. When I told them that a tongue tie might actually be the root cause of their oral myofunctional issues, or even their sleep apnea , I’m sure that some of them thought I was crazy. But in the last few years, things have changed so much! Initially, there was a small increase in the number of patients who were contacting me specifically about tongue ties. Dentists and orthodontists also began reaching out more frequently to discuss the application of myofunctional therapy exercises to tongue tie treatment. But in the last year or so, that little bit of interest has become a surge of awareness. Tongue ties and their effects on health and craniofacial development are finally becoming mainstream.
Read more