Temporary Crown on an Implant Replacing a Maxillary Central Incisor: Can You Clarify the Procedure?

I'm not sure how they got the impression of the gingival contour, but they may have used the actual abutment (or another abutment of the same dimensions) to complete the relining of the polycarbonate crown.

Many implant systems have temporary abutments that also come with temporary sleeves (I use Nobel Biocare and it is dead easy). I roughen the sleeve and reline the temporary composite (lab made) shell crown onto the temporary sleeve/abutment using a composite based temporary material eg luxatemp, protemp etc, remove the crown which is now attached to the sleve whilst it is still rubbery so that any excess will come out of the interproximal undercuts. Fill in any voids between the temporary crown/luxatemp and the sleeve with a flowable composite. I then trim up the excess to the edge of the sleeve (which is a perfect fit to the temporary abutment)and try it back in and adjust the emergence profile further if required so that it fits perfectly into the shape of the soft tissue from the extraction socket. I glaze it and place a vent hole palatally and cement with a small amount of temporary cement. A perfect fit and no cement into the gingival margin. It also has the advantage that as it is such a good fit if you have had to place any bone augmentation material round the implant to fill the socket this is held in place perfectly. This system is so predictable it is unblievably successful.

If the implant is correctly placed is easy, you have a pre made acrylic shell with the aprox shape and colour that you want and a palatal access hole. place the temp abutment,screw it on, place the shell with some composite resin (flowable)and cure it. remove the abutment with the shell attached, clean and finish relining with flowable resin, put in place , check occlusion and if the contour is ok, seal. if not , remove, apply resin, cure and replace, then seal. if the implant is emerging through vestibular, use an angulated abutment, and repeat the same sequence(there is no access hole and you have to cement the shell after the procedure is done but is pretty much the same.) the other way is to take a direct implant impression with sterile silicone and make everything in the lab... is good too but it takes longer. bets of luck.

Dr. F.....making a temporary crown for an immediately placed implant should be no different from the way you usually make temporary crowns on natural teeth. If you are worried about contaminating the surgical site with acrylic or composite, then you can simply cut a small piece of rubber dam, punch a hole and place it over the abutment. Put a separating medium on the abutment, fill the poly shell with what ever material you will use, and gently press and lift as the material is setting.... you do not want to get caught on any undercuts or striations on the abutment. Do it chairside,very fast to do, and you will save on the lab fee..... do pass the saving on to your patient. Gerald Rudick dds Montreal, Canada

Any anterior temporary crown should be made with only screwed -in temporary abutment, using a direct shell or an indirect prefabricated lab crown then bond it to the temporary abutment. I have learned (the hard way) that cementing an anterior temporary is disastrous, especially when gingival contouring is required to optimize the emergence profile. The sulcus will also be so much better for the final impression.