Restoring Bone Level Straumann Implant: Fixture Not in the Ideal Parallel Position?
Dr. P. asks:
I am about to restore a bone level Straumann implant in the 15 site [maxillary right second premolar] . At the preliminary visit, I noticed that the implant fixture is not in the ideal parallel position – not perpendicular to the plane of occlusion. And because the edentulous space is narrow, I fear the impression coping will contact the 16 [maxillary right first molar] before I can screw it down.
Can I cut and alter the impression coping before placing it? Will a normal diamond bur do it? As 16 is slightly mesially inclined, I will shave some of the mesial to gain a bit more room and create a better contact point. Any more suggestions?
4 Comments on Restoring Bone Level Straumann Implant: Fixture Not in the Ideal Parallel Position?
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Paul
8/10/2009
Your suggestions are what I would do.
Richard Hughes DDS, FAAID
8/11/2009
One can do several things depending upon how out of position. Simply take a fixture level impresson and let the lab square it away or move the implant and bone via a vital segmented osteotomy.
Mark P. Miller, DDS
8/11/2009
You seem to be describing altering the impression coping and yes you can alter it. Do not remove any of it that inserts into the implant, but you can reduce it on the sides in order not to touch the adjacent tooth. Use an open tray technique, not a closed tray impression post. Do your drilling out of the mouth. Mark the impression post with a Sharpie where you see it binding against the adjacent molar. Remove it from the implant, drill away whatever you need to (carbides always work better than diamonds)then reinsert the post into the implant. Look for space between the post and molar. When you've fully tightened the impression post you should see light between it and the molar. If not, remove it again and adjust until you are sure the post is passive in the implant. Then take your impression. It is an open tray so the post will now be buried in the impression material. Screw your analog into the post in the impression and you're done. The posts can even be shortened. The entire side can be removed. The only critical part is that which engages the internal of the implant. And the post can be sterilized and reused, so don't throw it away. It may come in handy some other time.
As an aside, you mean the implant wasn't placed exactly where the restorative table needed to be? That's probably the first time that's ever happened (tongue in cheek).
Robert56
8/11/2009
Call your Straumann
rep. If they cant answer, then email me
robert56@rogers,com
