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Presented at the American Academy of Restorative Dentistry Annual Meeting, Chicago, Ill, February 2013.
a
Clinical Instructor, Kois Center, Seattle, Wash.; and Private practice, Valladolid, Spain.
b
Founder and Director, Kois Center, Seattle, Wash.; Affiliate Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington,
Seattle, Wash.; and Private practice, Seattle, Wash.
c
Research Director, Kois Center, Seattle, Wash.; and Affiliate Instructor, Department of Restorative Dentistry, School of Dentistry, University of Washington,
Seattle, Wash.
d
Faculty and Scientific Advisor, Kois Center, Seattle, Wash.; and Private practice, Seattle, Wash.
Figure 1. Custom implant abutment. Figure 2. Obtain replica from direct impression of abutment. Polymeri-
zation shrinkage creates acrylic resin abutment with smaller volume than
titanium abutment.
Techniques for fabricating custom trial abutments14-16
have used occlusal registration material to fabricate a
copy of the custom abutment. In this technique, the
restoration is filled with polyvinyl siloxane (PVS) to
obtain a precise replica of the abutment. Subsequently, a
2-step, indirect cement procedure is used for the defini-
tive restoration with the PVS trial abutment.12 This
technique has some inherent shortcomings: If the PVS
trial abutment is narrow at the incisal edge, this may
break off inside the restoration, or the PVS trial abutment
may provide insufficient cement space.
The technique described benefits both stock and
custom abutments. Trial acrylic resin abutments
customized to match the shape of the definitive custom
abutment and the inside of the crown make this tech-
nique more predictable. Unlike the PVS trial abutment,
an acrylic trial abutment has less volume than the
definitive titanium abutment restoration that it is
mimicking. In other words, it is not an exact duplicate,
but a slightly smaller version. Therefore, when the indi-
rect 2-step cementation technique is used with an acrylic
resin abutment, a thin layer of cement uniformly fills the
inside of the restoration. The result is cementation of the Figure 3. Acrylic resin replica of titanium abutment.
restoration with a similar level of retention as a 1-step
direct technique, but with a minimum of excess cement.
the titanium abutment from the PVS. Fill the void
TECHNIQUE left by the abutment in the PVS impression with
fluid Pattern Resin (GC America) and place a warm
1. Fabricate the acrylic resin trial abutment after dowel pin into the acrylic resin to accelerate the
receiving the definitive custom titanium abutment setting of the resin. Remove the acrylic resin abut-
and definitive restoration from the laboratory ment from the dappen dish once the acrylic resin
(Fig. 1). Remove the titanium abutment from the hardens and remove the excess flash. The acrylic
replica. Attach the cervical portion of the titanium resin trial abutment has almost the same volume as
abutment to a thin wax bar and hang it vertically the titanium abutment (Fig. 3).
into a rubber dappen dish. Fill the dappen dish with 2. Apply a thin layer of petroleum jelly (Vaseline;
light-body PVS to cover the titanium abutment Johnson & Johnson) to the subgingival portion of
(Fig. 2). Once the impression material sets, remove the titanium abutment before placing the titanium
SUMMARY
This article presents a straightforward technique for
creating a customized acrylic resin duplicate implant
abutment in the dental office. It is cost effective and not
time consuming. It can be used with any implant-
cemented restoration and is especially useful when an
implant crown has a deep subgingival margin. Excess
cement is decreased while maintaining the retention of the
restoration.
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