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/
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/
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