Replace A Missing Lower Front Tooth Using A Dental Implant

Our case of the month for December involves the replacement of a missing lower front tooth using a dental implant. Dental implants are the best way to restore lost teeth; modern day techniques are minimally invasive, quick and virtually pain free. In our case, a lower front tooth was lost due to trauma. As you can see from the photographs, the tooth has been replaced with a virtually identical new dental implant crown.

Tagged with: Dental implant Tooth implant Dental implant crowns Lower missing front tooth

Aug 2015

30th

30th of August 2015

Dental implants- all ceramic crowns

As you will be aware, dental implants are the best way to replace missing teeth. Whether you are missing one, several or all of your teeth, dental implants can help. In the past, dental implant crowns (the actual tooth replacement) was a combination of a titanium abutment (screwed into the implant) and a porcelain fused to metal crown. This was fine and provided a perfectly good, robust result. However, for front teeth especially, the aesthetics of such restorations were possibly not great. Today, we are able to provide crowns with all ceramic fittings. This is usually with a zirconium abutment and an E max crown. We can now also use a screw retained all ceramic crown, which was previously not possible. Therefore there is no metal above the gum line; greater aesthetics and no chance of a black line at the gum level. If you would like the most aesthetic dental implant restoration for your missing tooth/ teeth, contact us- we will have the solution.

Tagged with: Dental implants Dental implants london All ceramic crowns Dental implant crowns Zirconium dental implants

May 2015

3rd

3rd of May 2015

Cement Retained Dental Implant Crowns

When restoring dental implants, the choice is screw retained or cement retained. Cement retained crowns will often be used when the screw access hole is not positioned down the long axis of the implant. There may be angulation issues or aesthetic issues that arise from this. Cement retained crowns may also be preferred by the patient due to the unaesthetic appearance of the access cavity for screw retained crowns, which often looks grey and discoloured if the underlying crown has a metal sub structure. Patients now often regard premolar and molar teeth as being in the aesthetic zone and are highly dental aware. Quite rightly, they expect dental implant crowns to look like natural teeth.

What Abutment Is Best for Cement Retained Crowns?

In my experience, Atlantis abutments are far superior to any other system. Think about how you would prepare a tooth for a crown and amplify the precision ten fold. With the digital age we live in, technology should be used to enhance the outcomes for our patients. This is one system that certainly does that. There are also other scanning centres which produce excellent abutments. It is worth talking with your dental implant technician and using a few systems. Of course, there is a cost implication involved and Atlantis may not be suitable for all.

How To Fit The Cement Retained Crown

When fitting cement retained crowns it is imperative that excess cement does not exude the margins and act as a plaque trap. This is one the main causes of Peri-implantitis and is avoidable.

There is an excellent technique which will help you to avoid any issues with excess cement:

1. Once you have verified the margins, occlusion, contacts, embrasure space and aesthetics you are ready to cement the crown.

2. Use your PVS bite registration material and insert within the crown creating a tag at the end to act as a handle.

3. Remove this index.

4. Mix the cement, which is usually a temporary cement (Tempbond NE) or a dedicated implant cement and place within the crown. Do not overfill. Make sure the abutment screw is covered. I use pre sterilised cotton wool.

5. Insert the index into the crown to remove the excess. This will leave a very fine layer of cement.

6. Place the crown and wait for setting. There should be no excess at the margins.

7. Perform the usual checks and take a PA radiograph to verify. There should be no exudate whatsoever.

8. A useful tip for removing any fine smears of Tempbond on the crown is orange solvent. Spray some onto a ball of cotton wool and clean any fine residue.

9. Review as required.

How To Remove Cement Retained Implant Crowns

There are times when implant crowns will need to be removed. For example, if the abutment screw loosens. This is why temporary cements are used. In my experience, cement retained crowns can be removed with minimal fuss. However, you must pre warn the patient that some force is required. I would over emphasise this fact. To avoid damage to the porcelain, use rubber coated crown removing pliers. GC have an excellent one. Grip the crown firmly and exert pressure in a bucco-lingual direction initially and then rotational. The crown should ease off within a few seconds.

How To Maintain Dental Implant Crowns

Dental implant crowns, screw or cement retained, require maintenance just as natural teeth. However, your hygienist must be trained in this field. Regular scalers, hand or ultrasonic, should not be used for fear of scratching the titanium. Satelec have introduced some excellent ultrasonic tips for implants. We have invested in these with great success. Specific implant hand scalers can also be used. We are also keen on adjunctive methods of cleaning such as Philips Airfloss.

Feedback

Article for dentists written by Dr Nissit Patel.

I hope this article has been of use. It comes from many years of experience of placing implant crowns, cement and screw retained. I welcome any feedback that you may have, please e-mail me: nissit@progressivedentistry.co.uk

My next article will focus on screw retained crowns.

Tagged with: Cement retained dental implant crowns Dental implants Dental implant crowns

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