Healing Abutment Rescue (Part 1)

There are several circumstances where we cannot dispose of specific prosthetic components to solve rehabilitation cases with dental implants, or that the components that we have at our disposal do not fit our needs to obtain an optimal emergency profile. Some of these situations among other could be:

First: In the exposure implant surgery stage we do not have the specific healing abutment which corresponds to the connection of that implant.

Second: We have the corresponding healing abutment but the diameter or height is less than needed.

Third: When we want to obtain a certain emergency profile that will fit the tooth to be restored and how to develop the personalized healing abutments.

Part 1

When receiving patients that had been treated with dental implants by other clinicians, is possible that the patient does not have the specific documentation and description of the inserted implant, and that radiographically we cannot distinguish the brand, model and connection of the submerged implant. In case that in the implant exposure surgery, none of the healing abutments available in the office fits the implant that we need to restore, we can act like we are going to show in the following images.

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Fig.1
This picture shows a model simulating the a common situation, where surgically the healing abutment is exposed.

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Fig.2
We remove the cover screw, determining in that moment the type of connection present in the implant. As we do not have healing abutments for that connection, we decided to create a healing abutment by bonding composite resins to the cover screw.

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Fig.3
The cover screw is thoroughly washed, decontaminated and ready to be prepared for the adhesive procedure.

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Fig.4
The external surface is sandblasted with 50 micron Aluminum Oxide particles until we achieve a homogeneous opaque surface. The surface will be washed with water spray and dried with air.

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Fig.5
We will apply a hydrophobic bonding over the treated titanium surface and thinned with air in order to avoid excess.

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Fig.6
We will prepare the body of the screwdriver by lubricating it with vaseline, creating a thin layer that will prevent the composite from sticking to the metal.

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Fig.7
The screwdriver is inserted firmly in the cavity of the cover screw.

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Fig.8
With a syringe, we will apply a small quantity of flowable resin, wetting very well the previously treated surface of the cover screw and embracing the body of the screwdriver tip.

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Fig.9
During light curing it is recommended to slowly rotate the ensemble to polymerize all the way around.

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Fig.10
With a metallic instrument and silicone tips, we will apply the composite paste, shaping the future healing abutment with the desired diameter and height needed for the clinical case.

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Fig.11
We light cure again, this time a long 60 second cycle, achieving a complete hardening of the resin.

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Fig.12
Now it is time to finish and polish the new abutment, with abrasive discs, abrasive rubbers, and brushes to give the final shape and gloss. A smooth surface is mandatory to facilitate hygiene and avoid plaque retention.

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Fig.13
On the left we can see a standard titanium healing abutment, and on the right the one modified using our technique.

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Fig.14
By sterilizing the healing abutment, we can immediately place it in the wound to star the healing stage.
TIP: Take into account that when introducing the screwdriver we should make it snap in the bottom of the titanium in order to avoid breaking the composite build up that can occur while twisting the screwdriver on the resin.

Conclusions

Here is just one option to solve a case in a situation that can occur; with these elements available in almost any office that performs implant rehabilitation, without using the required components of the manufacturer that were unavailable at that time.

Bibliography

1. Roberto Chaves. Restauraciones Protéticas Adhesivas. Ediciones Advance, 1991.
2. U. Bragger, L.J.A. Heitz-Mayfield. Biological and hardware complications in Implant dentistry. Editorial Quintessence, 2015.
3. Pedro D. Gazzotti. La rehabilitación Implanto Protésica. Editorial Porvidence, 2008.
4. Branemark, Zarb, Albrekstsson. Tissue Integrated Prostheses. Quintessence Books, 1985.
5. Patrick Palacci. Esthetic Implant Dentistry, Cap 8 159/202. Quintessence Books, 2001.
6. Carl E. Misch. Dental Implant Prosthetics Editorial Elsevier, 2006.

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