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.