Introduction to the case
Part 2 of yesterday’s case, which showed the extraction, placement, and temporary. View Part 1 of today’s case.
This patient has almost perfect teeth, but then developed external resorption of their upper right central incisor. They saw an endodontist who told the patient that it wasn’t restorable, and then the patient found their way to me. The patient has kindly allowed me to show their case.
I want to capture the sub-gingival shape I’ve created with this lovely temporary crown – so I need to make a custom impression post. That is VERY easy to do (and you don’t need to go to all the trouble that I have here).
First, take one standard impression post like this.
Add some red wax to protect the top and bottom of the impression post
Sand-blast the middle of the impression post (you don’t really need to do this bit – I just wanted to really go to town on it)
Steam clean and then sterilise it. You now have a normal impression post with a sand-blasted middle part.
This should be made well in advance of the impression appointment.
There’s something else that you’ll need to make in advance too….
…. take a standard sulcus former….
…. put it into an abutment holder, and start hacking into it with a TC bur….
…. until it looks like this.
Take a rubber wheel and polish off any sharp bits until …..
…. it looks like this. Then sterilise ready for the patient
Now here’s the part where some of the photos came out completely over-exposed (a fault with the camera, not the settings – but I found that out too late!!)
Here we are looking end-on at the temporary crown.
We take the temporary crown out and here is the sulcus. The white particles are some of the Osteogen graft that hasn’t been incorporated. I just blast that away with some air and water spray.
Look at the shape of the sulcus though. No normal sulcus former is going to fit in there whilst I’m customising the impression post.
Fortunately, I’ve got that sulcus former I customised earlier – now that fits just fine
Take a laboratory implant analogue, the temporary crown you’ve just removed and that impression post you sand-blasted earlier
Screw the temporary crown into the implant analogue
Mix up some impression putty….
…. and then squash it around the implant analogue and temporary crown. You want all the sub-gingival part of the temporary crown to be covered in the putty
Unscrew the temporary crown leaving the implant analogue behind in the putty. See how I’ve made a groove in the putty at the front of the crown
Screw that sand-blasted impression post into the implant analogue, lining up the post with that groove in the putty
Use some flowable composite to fill in the gap. It should stick to the sand-blasted surface of the impression post
Unscrew the impression post from the implant analogue and remove the impression post from the putty.
It might not look like much here….
…. but you’ve perfectly captured the sub-gingival shape of the temporary crown
Making that customised impression post has taken some time – thank goodness I had something in the implant to stop all that lovely soft tissue from collapsing in that time
Remove the customised sulcus former and screw in the customised impression post
Take a standard stock tray….
…. and make a hole in the tray where the impression post is
A small bit of red wax stops all the impression material flowing out when you fill it up
Take the impression. I’ve used Impregum
Here it is when it comes out. See the customised impression post in it
A simple alginate lower is all that’s needed
Take a shade with a black contrastor
Here is the same view with a Polar-Eyes filter on the camera. Our chief lab technician came and took a custom shade.
Then re-fit the temporary crown and get the patient back in a fortnight.
Here’s the crown on the model
Side view. Note how palatal the implant is.
This is a one-piece restoration. The crown has been bonded onto the abutment in the laboratory. There is no gap. There is no cement
Here is a close-up of the final crown in place, one month after it was fitted. All photos from here on have been taken AFTER I have probed around the implant.
Cervical shade isn’t perfect – though the patient is delighted
Here’s the occlusal view. Didn’t do too badly getting the long axis of the implant in the cingulum.
The one-piece restoration is screwed directly into the implant
I got some improvement in the fraenum, though I feel I could have done much better
Slight flattening of the labial soft tissue – but not too bad
Here’s the PA of the finished crown
And a happy patient