Implant Success: Planning and Impression Material Selection Are Key

Fig 1. A 55-year-old female patient presented with faulty maxillary full-crown restorations with wear on the incisal of tooth No. 8. The case involved the remake and placement of single restorations from the upper right second premolar to the upper left second premolar, with an implant to be placed in No. 10.

Fig 2. CBCT scan was taken to help plan placement of a 3.6 mm x 9 mm Astra Tech Implant System EV (Dentsply Sirona) implant and short healing abutment.

Fig 3. Implant in position No. 10 directly after minimally invasive transgingival guided placement; this approach enables faster healing and maintenance of soft tissue around the implant. The provisional was fixed on an oval pontic to create a subcrestal shape for the emergence profile for the definitive implant abutment.

Fig 4. HIPAA -compliant texting app (Awrel, awrel.com) was used to share, store, and document collaboration with clinicians and laboratory

Fig 5. Single restorations were placed from Nos. 4 through 12. For the implant in position No. 10, an open-tray impression technique was used to pickup the implant position. The open tray was chosen to maintain the most accurate relationship of the implant to the adjacent teeth.

Fig 6. The provisional used on an oval pontic created an emergence profile for natural papillae.

Fig 7. The stock tray was modified to allow access to the screw head of the implant pickup. Base plate wax was applied to the external side of the access hole of the implant pickup. The wax provides pressure to the material and helps control the flow of the material.

Fig 8. Aquasil Ultra+ Smart Wetting Impression Material was used for the impression of both the natural tooth preparations and the implant pickup. Delivery of the wash materials (Aquasil Ultra+ XLV, Dentsply Sirona) was accomplished with a handheld device with a fine tip applicator (digit Power® Dispenser, Dentsply Sirona). This provides extrusion with pressure and enables placement of the tip subcrestal to the natural tooth preparations and soft tissues around the implant pickup. The result is accurate capture of subcrestal natural tooth tissues and sculpted subcrestal tissues.

Fig 9. The use of Aquasil Ultra+ Heavy Body material allowed for the capture of all dental landmarks and surrounding soft tissue. In addition, the heavy body material has the firmness to capture an implant pickup for either closed- or open-tray techniques to maintain accurate orientation. The material, which features a pleasant mint taste, does not overflow.

Fig 10. Upon inspection of the model, the clinician was able to confirm the firm seat and engagement of the implant pickup to the impression and the accuracy of the surrounding soft tissue.

Fig 11. A patient-specific all-zirconia Atlantis abutment (Dentsply Sirona) was designed and manufactured with the approval of the laboratory and the clinician, as was an all-ceramic full-crown final restoration.

Fig 12. After a loading time of 8 weeks, the all-zirconia abutment was inserted with the assistance of an insertion guide. The final restorations were then seated and inserted.

Fig 13. Final restoration was completed as planned with a test of concept and placement of an implant in the position of the upper left lateral incisor. There were no complications with the implant. The result was a beautiful smile with restored esthetics, form, and function.