Advanced Prosthodontic

• Assessment
• Surgical consult forimplant placement
• Surgical appointment
• Surgeon’s OK to restore
• Restore

10 mm is the shortest implant used in NYUCD

• Radiographic assessment: Panoramic x-ray: 12 mm height from the crest of the ridge to the bottom of the mandible is necessary.
• If the patient has a good thickness of bone but has a knife-edged ridge,you may request for an I-CAT (3D image)

If the mucosa over the ridge moves as the lips are pulled.

o Assessment of attached mucosa:  Mucogingival junction demarcates the border between the attached gingiva and the alveolar mucosa.

o Assessment of the site:  Panoramic X-ray of highly resorbed mandibular ridge may show mental foramen assuming a more superior position on the crest of the ridge.

• *Minimum Mesiodistal width: 7 mmx
• *Minimum Faciolingual width: 7 mmx
• *Minimum interocclusal space: 7 mmx
• *Minimum bone height: 12 mm

• Most favorable area – mandibular anterior
• Least favorable area – maxillary posterior

• o Implant body is the analogous to the root of a natural tooth
• o Implant abutment connects the crown to the root
• o Implant crown is analogous to the coronal structure covered by enamel
• o Implant platform receives cover screw, healing abutment, impression coping, analog, abutment.

• Internal Tri-Lobe connection is used in NYUCD : the trilobe enables clinicians to easily feel it when placing the prosthetic components
• o “Replace-Select” (the type of implant we use to restore) is a user-friendly system because all the components are color coded.

Cover Screw

Healing abutment


Different height of healing abutment is used depending on the depth of the implant body.Taller healing abutment for deeply placed implant to prevent soft tissues from collapsing into the platform.

Impression coping

Implant replica (Analog)

• - Implant platform depth from gingiva <3 mm: either stock or custom
• - Implant platform depth from gingiva >3 mm: custom abutment because stock abutment collar is not high enough.

Considerations in deep restoration – Screwed VS Cement Retained:failure to remove the cement subgingivally causes peri-implantitisand implant failure.

• > 7mm space: Cement retained crown indicatedx 5mm for abutment + 1.5 mm for porcelain + 0.5 mm for metal
• < 7 mm space: Screw retained crown indicated

 Screw retained restoration does not have an abutment. Because there are less components involved in restoration, less space is necessary.

loose screw

• Fixed titanium screw must be torqued to 35 Ncm
• Locator abutment (in OD) must be torqued to 30 Ncm

• Patient presents to clinic with healing abutment
• 1) Identify the platform and remove the healing abutment
• 2) Place the impression coping and TAKE THE VERIFICATIONX-RAY
• 3) Take the final impression
• 4) Connect the analog to the coping embedded on theimpression material
• 5) Place healing abutment back intraorally
• 6) Make impression of opposing arch
• 7) Make interocclusal records
• 8) Take shade
• 9) Send to laboratory
• 10) laboratory applies soft-tissue moulage (analog gingiva) around the impression coping to maintain the contours of the tissue around the implant
• 11) Mast cast is fabricated with special stone with resin. Resin minimizes the volumetric change of the stone as it sets
• 12) Place in the abutment and fabricate the restoration
• 13) After receiving the crown from the laboratory, removethe healing abutment, seat the abutment, and verifyseating with radiograph.
• 14) torque the abutment to 35 Ncm
• 15) Close access to screw with cotton pellet & temporary material or Wax
• 16) cement the restoration

Open tray impression

• ~Border mold the custom tray
• ~ take an impression with alginate
• ~ cut out a window at the position of the displaceable tissue
• ~ capture the moveable tissue with plaster
• ~ capturing the tissue at rest