Dental Implants: Temporary Abutment Cylinder

sure!( i'm regular gp with no financial interest) I would recommend that you use something like protemp garant from 3m espe which is a composite for temporaries. doesnot heat on curing and handy on seringe. or 1/index 2/ pour fast setting plaster and analog 3/ do it outside the mouth, adjust and disinfect- better for many reasons... and less chairtime. very good confs about that on ao's cd of 2004

I would do as recommended in the previous post. That is indirect using an analog. Pro Temp Garant is a Bis-Acryl with not very good wear capability. Not meant for more than a couple of weeks. However a Poly Methyl Methacrylate is more durable for long term use as in implants. The ultimate which I use routinely is (since I am a CEREC User) is a CAD/CAM restoration that I mill from an impression taken at the surgery appointment. I can develop an anatomical abutment or cast one and then mill my provisional/final restoration. The restoration is placed 1-2 weeks after the initial surgery or it can be ready and waiting for uncovering at a later month following full integration.

The best way I have found to do this, is to do all the trimming outside of the mouth. I also agree with using a temp material that does not heat up(there are many-luxatemp, protemp etc...) The way to do it outside of the mouth is to 1. using a wax up and suck down template, cure the temp material over the abutment(final abutment or "temp abutment") in the mouth, remove from the mouth and use an implant analog and abutment analog(or actual abutment, taken back out of the mouth) use flowable composite or acrylic and "flow" the material from the rough temp on the analogs, down to the exact margin. you can contour and polish the newly formed temp, and then cement it using temp bond.

I am a periodontist and therefore I think a little differently than the restorative dentists. I reduce the temporary cylinder so it is short of contract outside the mouth and then connects this to the pre-made provisional crown with just use enough jet acrylic to rigidly lock the provisional crown to the cylinder. I then remove the entire assembly and paint the remaining contour and emergence profile on the connected cylinder and restoration. This is then completley finished and polished before screwing into place. the occlusion is then checked and adjusted and the access opening sealed with cotton and cavit or temporary cement.

I did one of these today and the truth is there are lots of good ways, all have some good and some bad features. You can use a wax mould or PVS of the provisional denture or a denture tooth, then cut the temp cylinder to length as you did and screw it in . Block with wax or cotton and cavit then make the temp. Instead of waiting till the next apt to drill in to find the screw do it now and trim the case, then reinsert and block with cotton and cavit as you would a root canal.

For provisionals, I use either a polycarbonate crown form or an egg shell provisional. Fit this over the temporary cylinder, then take a cotton tip applicator and break off an inch of the stick. Vaseline the stick and put this into the chimney of the temporary cylinder, then fit the premade shell over it. Punch a hole in the shell so the stick fits through, then reline with any self cure methylmethacrylate. After it has cured, remove the stick, leaving an access chimney to the screw. Unscrew the abutment screw and finish the provisional extra-orally. Finally, screw retain the provisional so no cement gets under the tissue, filling the access hole with a cotton plug then composite or triad.

Is anybody taking any precautions regarding the flow of the arylic into the surgical site? If yes, what/how? I've been using rubber dam, but never liked it.

I truly hope that the temps you are making on these temporary abutments are made on a two part temporary abutment. Most temporary abutments are one part. Just think about the complications you will experience when you have drilled the hole to where the tool fits into the temporary abutment and you find that you can not turn the tooth/ bridge out! You may save costs initially by using this method, but it is not worth all the complications. Some implant companies have titanium cylinders availabe with knurling for retention of acrylic/composite. These are inexpensive and can be used for definitive restorations as well.I have never recommended curing acrylic in the mouth.I also agree with the previous post by making the provisional indirect.

The problems could decreased if you use only a bit of resin to block out the temporary crown in the selected position, and then, after set, unscrew the provisional restoration, add more resin and finish it screwed in an analog or a laboratory handle, but always out of mouth, that will improve the finishing and the quality of the margins.

I agrre with alec. I do the same way. I reduce the temporary titanium abutment to the desired lenght (in an abutment holder, not over the implant) and just "capture" the position of the provisional crown in the mouth with a litle bit of resin. After that, I remove the povisional/abutment and complet with resin out of the mouth using an abutment holder. Contour and finishing is performed out of the muoth. After that, i just install and check the oclusion (non contact load).

For immediate temporization as well as immediate placement with temporization I choose the Zimmer system. They have a plastic abutment with a fitted hex to prevent rotation. With anterior teeth I will sand blast the upper portion of the plastic. I then add luxaFlow to the plastic abutment so that it is a custom fit of the emergence profile of the extraction socket up to the tissue level. This is polished and cut to height and screwed to the implant. Then I will close access with cotton, place Revotec LC into polycarbonate crown, remove excess and light cure to the abutment(this should be lubercated). This will prevent the heat problem as well as locking to place, or attaching to sutures. The margin being at the tissue level prevents cement from hiding under the gingiva and it ends up looking pretty good as well. Use one of the new temporary resin cements and you are good to go.

Nearly all the posts show that many techniques will work and are being done successfully. I especially like the post from a periodontist colleague. The vast amount of my experience over the past 20 years with implants has been with the Straumann system. Many systems have good temporary titanium posts. I use polycarbonate crowns whenever possible because they are extremely color stable, easy to work with, and hold up better than any of the bis-acryls out there. We tack them in place with a minimal amount of Holmes Quik-Set and complete all remaining procedures out of the mouth on an analog being held by an analog holder. Straumann and Astra have 2 very good ones that can be used with any system's analogs/replicas. Yes, Quik-Set generates a lot of heat, but it never comes in contact with tissue or implants and we cool with a triplex syringe vigorously during the exothermic portion of the set. The set occurs in 1-2 minutes. That's why I like it. It's fast. Then either Quik-Set or Jet can be used. Nice to see there is more consensus on provitionalization than the placement of implants. My we are a judgmental bunch, aren't we.

i use a denture tooth hollowed out, screw access blocked with a piece of plastic from a cotton bud/q-tip, which is perfect 2.6mm for screw access. denture teeth offer excellent blockout of the Ti core, excellent esthetics, easy to trim and polish, blah blah blah. I index it with a dollop of resin, position esthetically and then add outside the mouth using the commercial analog holder to hold it. alternatively, a "pin vise" from an engineering supplier at a fraction of the cost helps hold for trimming polishing etc. more details and excellent sequence of pics available by email at request. cnhart@mac.com

well I think that every one made there contrubution with reagrds to the question @ hand. However I agree with the periodontist colleague and also the other guy who uses the q-tip e.t.c. Continue advancing your dentistry and God Bless.