Upon case analysis in the laboratory, it was determined that this would be a good opportunity
to use the Nobel Procera ASC (angulated
screw channel). The ASC system would allow
up to 25 degrees of angulation change, the use
of porcelain fused to zirconia, and thusly
achieve the more desirable screw retained option. With its unique Omnigrip driver and screw
head (both with blue markings for easy identification), the access hole could be moved into a
more favorable location and still easily engage
the implant.
The case was scanned and then designed with
the Nobel software. A zirconia abutment on a
titanium platform was made. The titanium base
is "friction-fit" and can be easily removed for
porcelain firing. Porcelain was applied in the
standard fare using Vita VM9 porcelains.
The crown was seated into the implant just as
easily as any other screw retained crown. The
esthetics and function of the crown were not
compromised as a result of utilizing the ASC.
Interproximal contacts were adequate and very
limited occlusal adjustment was necessary. The
single unit crown has maximum intercuspation
occlusion with no excursive contacts. The
crown was easily torqued to 35Ncm utilizing the
Nobel Biocare Omnigrip. As can be seen from
the photos, the screw access opening is now
at the central fossa and can be easily accessed
with normal operating procedures.
Conclusion
The concerns over implant failures due to unseen cement being left behind, the ease of retrieval, and the technological advancements
have raised, or arguably returned, screw retained restorations as the "go to" restorative
choice. New options like the Nobel Procera
Angulated Screw Channel System allow clinicians to place highly esthetic porcelain fused to
zirconia screw retained restorations in situations where implant angulation would have
earlier demanded a titanium abutment and
cementable crown.
Dr. Clark Giddings is a
general dentist with a
practice in Stephenville,
TX. He gradated from
the University of Oklahoma with a degree in
Business Management,
then completed his dental training at the University of Texas Health
Science Center in San
Antonio. He is a member of the ADA, TDA, and
Fort Worth District Dental Society.
Kyle Swan, CDT is coowner and managing
partner of Functional
Esthetics, Inc. Kyle has
been a ceramist for over
20 years and, together
with his partner Phil
Watkins CDT and their
team of excellent technicians, enjoys being an
integral part of the interdisciplinary team. Kyle is a member of the American Equilibration Society, the AACD, and is a
contributor to Inside Dental Technology.
Acknowledgements
The authors would like to thank Jason T. Beck,
D.D.S., M.D. and Mr. Jim Lawlor for their contributions.
www.houstondentistrymagazine.com
Functional Esthetics, Inc.
886 North Mill St. Lewisville, TX
(972) 221-7288
www.functionalesthetics.com
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