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Placing Implant Abutments

welcome to the University of Michigan

dentistry podcast series promoting oral

health care worldwide

for today's demonstration we have our

hypothetical patient and we have used

our surgical guides to physically place

the implants in order to get to the

place we are now we remember that

originally our patient had no implants

in place and we had a model of our

patient on our model we determined the

physical location of the implants and

marked them and then we blocked the

model out so that we could make our

x-ray guides followed by our surgical

guides so here's an example of a blocked

out model for our patient many times to

determine the location of the implants

in the posterior area we may do a

diagnostic setup in this case we set a

couple denture teeth in the area where

the teeth were missing in the posterior

so having determined the location of our

implants we went ahead and with another

blocked out model we made a radiographic

guide

note how the buccal aspect of the

radiographic guide has been contoured to

simulate where we would like the final

gingival margin on our restorations to

end up and so by making that contour on

our radiographic guide at the time the

surgery is done the surgeon can place

that guide on the patient once they have

laid the flap in this area and then when

they go ahead and contour the crest of

the ridge prior to placing the implants

they contour the crest of the bone the

ridge crest using the ridge crest

preparation guide so what they will do

is take their 2.8 millimeter

measuring stick that comes with their

surgical drills and they will make sure

that they have relieved the bone in

these areas so that the bone is 2.8

millimeters lower than the final

gingival mark

and likewise the same thing was done

where our single tooth implant

is in place we had made our single tooth

radiographic guide in Ridgecrest

preparation guide as well and we can see

that this was fabricated in such a way

that the cervical extent of the

radiographic guide was consistent with

the free gingival margin of the teeth on

either side of the proposed implant

placement and then we've now waited

three months for healing so now we're

ready to take our impressions for the

patient and finish their restoration in

preparation for taking the impressions

for the patient you want to go and get

the green requisition form that's

available at the dispensing desk

so I'll set our requisition off to the

side and when you checkout the implant

ratchet set this is our toolkit for

doing the prosthetic portions of our

implant restorations we have a torque

wrench we have some screwdrivers for

placing the various components on our

implant restoration so if we take our

patient and I pick out a screwdriver and

you can see it may show up reasonably

well the end of this looks a little bit

like a star shape or a Torx wrench now

that shape is also the recess in the top

of our healing screws and so this wrench

fits very securely into the little

healing screw now many times from

patients come back for their 3-month

visit there will be little bits of food

debris that plug up this little recess

so what one wants to do is take an

explorer and go in here make sure any

food debris is cleaned out and then

rinse it with an air water syringe once

that's been completed the screwdriver

fits into the end of our healing

abutment and we carefully just remove

unscrew the healing abutment and that

will lift right away

so when that's been done you can see the

soft tissue tunnel or tube that goes

down to our regular neck implant so the

healing screw has been taken off and

we're going to now come back and place

our regular abutment on does the real

abutment that goes in the patient's

implant and you can see that the solid

abutment has a flat side on it that's an

anti rotation side and then 180 degrees

opposite the flat side is a small groove

on the side of the salad above them so

now for placing the abutment in the

implant we take one of the drivers that

has a hollow opening in the top of it

and where the small black line is it's

difficult to see but on the inside of

this hollowed out driver is a small

little positive bump and so when we

place the solid abutment in the driver

we line the groove up with that black

line and then those will friction fit

very nicely so we place our solid

abutment in the driver again lining the

black line on the driver up with the

groove on the solid abutment that's

placed in our patient lined up carefully

and we just tighten that down finger

tight as tight as we can get it now I'm

going to set our patient to side just

for a moment and take the pieces of our

torque driver out of our prosthetic kit

so these two pieces of the torque driver

fit together one slides into the other

and you can see how this end shouldn't

be crossways it should fit in snugly and

the other part of the device goes in the

barrel and is screwed in place so those

three pieces assembled our torque driver

is now assembled and the end of it by

our flexible wire there's a little arrow

on this piece the arrow points toward

the flexible wire the torque driver fits

over the top of our abutment driver

and now when we torque this to 35

Newton's centimeters we touch only the

flexible wire portion and we torque that

until we see that deflection go to 35

Newton centimeters and once that's

deflected to 35 Newton centimeters we

have now torqued our abutment to

manufacturer's specifications what I'm

going to do now is in like manner I'm

going to remove the healing abutment

from our wide neck implants now the one

difference between the wide neck and the

regular neck solid abutment is the wide

neck abutment is large enough on the top

that the nut driver that you use to

remove the healing cap is exactly the

same one you can use to place the solid

abutment so here we place the solid

abutment on that's our wide neck solid

abutment and here again we take our

torque driver the torque driver fits on

this just like it did the other we now

go ahead and start torquing this until

we have when we look at our torque

wrench we have 35 Newton centimeters of

torque so that we know this is then

torque to manufacturer's specifications

for our patient we now have our regular

neck abutment placed and our 2 wide neck

abutments placed the next thing we want

to do is to take a poly vinyl impression

of our implant abutments in place you've

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