Index implant placement at time of surgery. Zimmer TSV implants were indexed using a modified surgical guide and the Zimmer carrier provided with the implant for placement.
- Tighten implant carriers to light hand torque
- Ensure the implant carriers are seated
- Ensure the guide/matirx is seated fully on the patient's teeth
- Ensure the implant carriers do not touch the guide index
- Apply GC pattern resin carefully around the implant carriers.
- Ensure the resin does not enter an undercut area of the adjacent teeth
- Leave the access hole to the screw of the implant carrier free from resin
- Ensure sufficient resin is adapted around the carriers to ensure regidity
- Allow GC Resin to set for 10 min
- Remove and disinfect appropriately
- Remove stone from previous cast to allow room for implant analogs
- Place index on cast
- Ensure the index is seated fully and pasively
- Hand tighten appropriate lab analogs onto index implant carriers
- Place index with lab analogs onto cast
- Ensure the lab analogs are free from contacting the stone cast
- Make a boxing wax matrix around cut out area on cast
- Mix and pour low expansion stone around the lab analogs
- Do not cover the junction of the implant and carrier with the stone
- Ensure the matrix remains fully seated and doesn't move
- Allow stone to set
- Remove Index
Provisional Implant Crown Fabrication
- Modify Zimmer implant carriers to be used as temporary implant abutments
- Place implant carrier on a implant analog and place it into the Zimmer Implant Lab holder
- Cut off the coronal section of the implant carrier
- Sand blast the color off the carrier
- Place provisional abutment back onto the indexed cast
- Fill screw access hole with impression material (PVS)
- Block our undercut areas on cast and under temporary abutment with impression material (PVS)
- Place reference lines on the cast indicating the buccal/lingual and mesial/distal location of the implant
- Fabricate Provisional fabrication matrix from diagnostic wax up
- Fill provisional matrix with polymethylmethacrylate acrylic of the appropriate shade
- Place resin filled matrix on cast with and ensure complete seating
- Place cast with resin filled matrix into a pressure pot with warm water for about 10 minutes at 15 psi
- Remove form pressure pot
- Using a 4 round bur expose the implant screw access hole using the previously marked implant location lines
- Remove the PVS impression material in the screw access hole
- Remove the provisional implant crowns from the cast
- Trim provisional implant crowns of excess resin bulk/flash
- Using a thin diamond disk section between the two implant provisional crowns
- Brush bead acrylic onto the cervical portion of the provisional abutment to provide proper crown emergence contours
- Place in pressure pot with warm water at 15 psi for 10 minutes
- Remove and modify crown contours until you feel the crown exemplifies ideal crown contours
- Adjust proximal contacts until shims can be pulled through the interproximal with light resistance
- Polish with pumice and crest shine on a lathe
- Place finished provisional crowns back on indexed cast
- Flow impression material (PVS) around the provisional crowns representing the ideal gingival locations
- Allow 5 minutes to set
- Remove implant provisional crowns
- Evaluate Crown cervical contours in impression material
- Place Open tray impression post onto appropriate implant lab analog
- Apply flowable composite resin or polyether impression material around the impression analog filling the molded area. Light cure or allow time to polymerize
