Lateral Incisor Implant Placement and Provisional

Introduction to the case

Pt. presented to my office w/ multiple congenitally missing teeth and existing upper/lower acrylic partials. She finally made up her mind to move into implants to improve her quality of life. For #7, a Nobel Replace select 3.5 X 11.5 was placed and immediately temped w/ a screw retained provisional made over a plastic engaging cylinder w/ access hole through the cingulum. Tooth was taken out of occlusion and all excursions. Pontic was easily cut off her existing partial. I placed the top of the implant 3mm apical to where I wanted the margin of the facial tissue to settle, which buried the implant .5-1mm subcrestal. A final radiograph was taken w/ the screw retained temp in place and I noticed that the cylinder was not completely seated, probably because of the subcrestal placement. Being this is a provisional restoration, I didn’t think much of it, but was curious to see everyone’s thoughts.

When I made the provisional, I screwed down the engaging cylinder, but did not take a confirmation radiograph (mistake?). I then loosened the screw so I could pull the cylinder out with the luxatemp synch impression (mistake?). Either one of these reasons could be why the cylinder was not seating all the way on the final X-ray. Would like to hear everyone’s thoughts and comments about how they make this type of screw down provisional and if they would be concerned that it is not seated all the way. Thanks