Dentaltown January 2021 - 60

Fig. 10a

portal to the lab and the abutment is physically sent to
the lab for fabrication of layered zirconia restorations.
In cases where the bone is wider, a properly placed
implant will allow for a screw-retained restoration
(which is always preferred). In this case, however, even
though the implant is placed against the palatal bone,
the angulation of the ridge in relation to the tooth
position allows only for a cement-retained restoration
(Figs. 11a-e). If this crown were made for screw retention,
the access hole would pass through the incisal edge and
compromise aesthetics.
If there's any doubt whether screw retention is truly
preferable, consider the fact that more than 80% of
peri-implant-diseased sites are associated with excess
retained cement.13 This being said, if cement is used,
it is practical to use a radiopaque one. There are many
radiopaque cements on the market to choose from, all
of which offer the same advantage of being able to see
residual cement at the crown-abutment margins. Great
care should be given to cleaning the excess cement after
cementation.

Fig. 10b

Fig. 11a

Follow-up review and checks

Fig. 11b

60

A lecturer I admire very much once told me that
anyone can show you a picture or a periapical X-ray of
an anterior implant and brag about it, but if they really
want to prove their protocols, have them show you a
follow-up CBCT image. Since then, I try to always take
follow-up 3D images to perform a self-evaluation. It is
good practice to check your work, as well as to share
cases with colleagues so that they may help keep you
accountable to your protocols. (See Fig. 12.)
The last component to this case on the day of delivery
is ensuring this patient has a protective occlusion. In
single-case implants in the anterior, I have always interpreted that to mean little to no occlusal contact without
compromising aesthetics. To explain this with a common
reference point, shimstock-hold would be considered too
heavy. Shimstock is about 8 microns in thickness, and I
strive to set the occlusion so that I can pull the shimstock
through the bite with little to no resistance.
There will be some load by virtue of the volume of
food when eating, so keeping the occlusion that light
will not underutilize the supporting bone. However,
being that the most favorable load forces are axial forces
and that the angulation of anterior implants within
the periodontium lead to a high degree of unfavorable

JANUARY 2021 // dentaltown.com

DT0121_Horton_CE-Implants.indd 60

12/17/20 12:39 PM



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Dentaltown January 2021

Table of Contents for the Digital Edition of Dentaltown January 2021

Dentaltown January 2021 - Intro
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Dentaltown January 2021 - 1
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