Problem #7: Images for Implant Procedures
Discussion: Imaging during implant surgery and restorative procedures is critical to success. Verification of the seating of components (healing caps, impression copings, and abutments) is mandatory prior to the fabrication of crowns, bridges, and dentures, whether in-house or at a contracted lab.
Solution: Identifying the platform, the flat top of the implant, is the first step. Most important: the vertical angulation of the PID must parallel the position of the component to the implant platform. A bitewing holder is most successful, as it tends to be more stable in the mouth, do not use an aiming ring, simply follow the top of the implant. A vertical bitewing holder should be used when the bone levels have resorbed away from the occlusal plane. Periapical holders can be used without the aiming ring. Simple sticky tabs can be used with a hemostat. Due to the position of the implant in the jaws, maxillary implants require some degree of positive vertical angulation, while mandibular implants require some degree of negative vertical angulation. A series of images for #20 (impression coping, abutment, cemented crown on abutment) using a bitewing holder and a periapical holder is shown in Figure 32. An impression coping not fully seated is shown in Figure 33, along with the corrected position and periapical view of the final implant crown fully seated. An open, not fully seated, abutment and crown is shown in Figure 34
Figure 32 - Implant #20.
(A) and (B) Impression coping. Implant platform not captured in (A). Sensor re-positioned lower in the mouth to capture the interface in (B). (C) Abutment fully seated. Image is diagnostic, excessive vertical angulation was used. (D) Crown cemented, platform captured with ideal vertical angulation.
Figure 33 - Implant #7.
(A) Impression coping not fully seated. (B) Impression coping repositioned and fully seated. (C) Final image of abutment and crown fully seated.
Figure 34 - Implant #21.
Abutment/crown not fully seated verified by radiolucent gap (red circle).