Houston Dentistry Magazine Volume 1 Issue 1 - Page 13

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 | HOUSTON DENTISTRY 13