SMILES SPOTLIGHT in the LEADERS IN TEXAS DENTISTRY CREATING UNFORGETTABLE SMILES A new screw retained option More and more clinicians these days are moving from cementable restorations to screw retained. Even though the demand is higher, a screw retained crown is not indicated in every situation. Many times the implant is placed where it has to go, only to leave the angulation such that a titanium abutment and cementable crown are the only options. The new Angulated Screw Channel System from Nobel Procera is changing that limitation and opening up new possibilities. 12 HOUSTON DENTISTRY | www.houstondentistrymagazine.com A Better Angle Case study The patient is a 43-year old female. Other than a penicillin allergy, her medical and social histories are noncontributory to her treatment. Tooth number 3 has an extensive treatment history dating back 25 plus years, including restorations and eventually endodontic treatment. The tooth was never restored with an indirect full coverage restoration after root canal therapy. Several years later the tooth fractured and was deemed non-restorable. The tooth was extracted sometime around 1992. The patient then wore a unilateral single tooth removal partial denture to replace number 3. This appliance was worn for about 5 years before the patient stopped wearing it completely. For 15-20 years, the edentulous number 3 area was not restored. Opting now for treatment, options were reviewed with the patient along with risks and benefits. The patient elected to have an implant placed and restored with a single unit crown. Due to bone resorption from the amount of time lapse and anatomical limitations of the inferior border of the right maxillary sinus cavity, sinus augmentation would be necessary. Sinus augmentation was performed and a Nobel Biocare Active RP 5.0 x 10 implant was placed. Once osseointegration was complete, the implant was ready to be restored. Due to anatomical concerns, the implant was placed at a bucco-palatal angle. After the impression coping was placed it was easy to see that, if a screw retained restoration was to be used, the access opening would be located on the top of the occlusal third of the buccal surface at the buccal groove. In this particular case, it was going to be next to impossible to do a screw retained restoration, which would be contrary to our desired optimal treatment. Disappointingly, it seemed that most likely a stock angled abutment with a cement retained restoration would have to be utilized.