Since the abutment shape will influence the soft-tissue contours it is important to have the shape of the abutment modified by the dental technician in preparation for the exposure. This requires that the impression is taken during first-stage surgery.In cases where it was not appropriate to take an impression during implant placement a preselected abutment may be used. The manner in which it will influence the contours can be assessed by trying in the abutment. Modifications of the abutment can be made outside the mouth by attaching it to an implant analogue. A reduction in height is most commonly required or, alternatively, a reduction of the labial surface may be needed to avoid gingival recession. With implants placed at an angle special care should be taken when attaching an abutment with an anti-rotational mechanism other than a Morse-taper. Either the rotational position of the implant should have been adjusted during placement, or abutments with rotational offsets should be used. This is critical when angled abutments are being used. Reduction of the labial aspect of the abutment may also be limited by an external hex and the fixing screw.
The position of the abutment should be verified by use of the diagnostic template and should not interfere with occlusion. The abutment should be fitting within the prosthetic envelope. Multiple abutments should be aligned parallel to each other and adjacent teeth in order to facilitate the construction of restorations.Seating the abutment.The clinician will need to ensure that the abutment is completely seated.A radiograph may be required to confirm complete seating. Abutments using a tapered connection can be tested by simply applying finger pressure to engage the taper. If the taper does not engage, some obstruction - such as soft or hard tissues may be present and will need to be removed prior to tightening. The fixation screw for the abutment can be tightened to the desired torque, which may vary from 15 to more than 32 N cm,depending on the type of connection.
The access hole for the fixation screw should then be blocked. The ideal method is to use soft wax to cover the screw, following by glass ionomer cement to seal the access hole of the abutment. This will eliminate the undercut to facilitate the relining or construction of a provisional restoration.
Wound closure
Generally the incisions designed for minimal exposure such as the H - shaped incision,do not require suturing, as the abutment and the transitional restoration occlude the opening. On rare occasions, when attached tissue has been re-positioned, fine labial sutures (6-0) may be used in order to close any incision lines.Full - thickness flaps should be closed using appropriate sutures (usually 3-0). The pedicle flaps created by the S-shaped incisions require finer sutures (4-0 to 6-0) to create the papillary form, which will be supported by the transitional restoration. Sliding flaps from the palate require stronger sutures (usually 3-0) and may be secured by tying them to the abutments. Supplementary dressings (such as periodontal pack) may be used when tissues are denuded. However, this should be avoided.
The position of the abutment should be verified by use of the diagnostic template and should not interfere with occlusion. The abutment should be fitting within the prosthetic envelope. Multiple abutments should be aligned parallel to each other and adjacent teeth in order to facilitate the construction of restorations.Seating the abutment.The clinician will need to ensure that the abutment is completely seated.A radiograph may be required to confirm complete seating. Abutments using a tapered connection can be tested by simply applying finger pressure to engage the taper. If the taper does not engage, some obstruction - such as soft or hard tissues may be present and will need to be removed prior to tightening. The fixation screw for the abutment can be tightened to the desired torque, which may vary from 15 to more than 32 N cm,depending on the type of connection.
The access hole for the fixation screw should then be blocked. The ideal method is to use soft wax to cover the screw, following by glass ionomer cement to seal the access hole of the abutment. This will eliminate the undercut to facilitate the relining or construction of a provisional restoration.
Wound closure
Generally the incisions designed for minimal exposure such as the H - shaped incision,do not require suturing, as the abutment and the transitional restoration occlude the opening. On rare occasions, when attached tissue has been re-positioned, fine labial sutures (6-0) may be used in order to close any incision lines.Full - thickness flaps should be closed using appropriate sutures (usually 3-0). The pedicle flaps created by the S-shaped incisions require finer sutures (4-0 to 6-0) to create the papillary form, which will be supported by the transitional restoration. Sliding flaps from the palate require stronger sutures (usually 3-0) and may be secured by tying them to the abutments. Supplementary dressings (such as periodontal pack) may be used when tissues are denuded. However, this should be avoided.
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Orthodontic dentist in Chandigarh