Conversion of Immediate Temporary Abutment to Final Milled Custom Abutment

A failing right central incisor.

Atraumatic extraction site.

A custom temporary abutment is fabricated at the time of implant placement that captures and supports pre extraction gingival profile and tooth emergence.

The PFM crown is salvaged from the extracted tooth and retrofit to the custom temporary abutment and serves as our provisional restoration.

After five months of healing in this case, the patient returns for implant level impression. The custom temporary abutment is removed for the first time since the day of surgery to accomplish this.

The custom temporary abutment (CTA) is connected to an implant replica (analog). The CTA and analog assembly are then placed into a sectioned 5cc syringe. Sterilization tape is utilized to stabilize this setup. Any low viscosity PVS works well.

Care is taken to fill at or just above the CTA margin so that once set the CTA may be removed without tearing or having to cut the impression material.

Once the impression material has set, the abutment screw is removed and the CTA pulled, leaving the analog in the impression. The implant impression is then pulled from the mouth.The CTA and provisional are replaced and the patient is discharged.

The soft tissue model often only recreates the impression coping dimensions and not the actual sulcus shape.

Pattern resin and syringe with an 18ga needle utilized in replicating the CTA emergence.

A plastic temporary abutment is connected to the analog captured in the CTA impression. Pattern resin is mixed thin, placed in the syringe and injected into the impression void while still at a low viscosity.

Once the pattern resin has set it is pulled from the impression. Minor voids in the resin may be filled with wax.

The soft tissue model is altered if necessary to allow the abutment to fit easily. Axial walls are then finalized.

The final waxed pattern is scanned on the Procera Piccolo.

From the 3D digital rendering, a ceramic abutment and coping are milled.

The CTA at six months, the day of final delivery.

Implant sulcus.

Custom ceramic abutment in place with no tissue blanching.

This process allows for capture and preservation of pre-extraction architecture, high cement lines, and minimum site exposures.

Final restoration in place with little or no soft tissue movement.

Final smile.