Restorative challenge: A 45-year-old female presented with a missing maxillary right central incisor. She was wearing a removable partial denture but was not pleased with its esthetics, phonetics and function (see Figure 1).
Treatment plan: Since the patient presented with a thin, translucent periimplant biotype, the gray color of a metallic abutment would cast a dark hue through the facial periimplant tissues and have a negative impact on the overall esthetics of the implant restoration.
The dental team chose to use Encode Abutments from BIOMET 3i because they can be coated with a gold-colored titanium nitride to eliminate the dark, gray hue associated with metallic abutments, resulting in a warm gold hue; the abutment would be restored with a PFM crown. Their diagnostic tools included radiographs, diagnostic casts and wax pattern, and a surgical guide.
Restorative team: Carl Drago, DDS, MS, performed the clinical restorative treatment and Garry O'Connor, DDS, MS, performed the surgical treatment; both are from Gundersen Lutheran Medical Center, La Crosse, Wisconsin. Tom Peterson, CDT, MDT, owner, North Shore Dental Laboratories, Lynn, Massachusetts, fabricated the porcelain-bonded-to-metal crown. BIOMET 3i designed and milled the Encode definitive abutment.
Case study: Dr. O'Connor used a two-stage surgical protocol: he placed a 5mm-diameter implant in Stage I and, after osseointegration, he performed Stage II surgery to uncover the implant. After the soft tissues had healed, an implant-level impression was made and sent to North Shore Dental Laboratories to make a master cast with an implant lab analog. After the cast was poured, an Encode Healing Abutment of the appropriate size (5mm platform; 6mm emergence profile; 4mm height) was placed into the implant lab analog (in the cast) and an alginate impression was made.
Peterson poured the impression in Type IV die stone, pinned and sectioned the cast and sent it to BIOMET 3i's ARCHITECH PSR® Department, Palm Beach Gardens, Florida for design and milling of the Encode definitive abutment (see Figure 2).
The ARCHITECH PSR laboratory technician evaluated the scans and designed the Encode Abutment using a proprietary, sophisticated computer software program (see Figure 3).
The Encode Abutment was milled from a solid blank of titanium alloy per the specifications of the computerized design and a gold-colored titanium nitride coating was applied (see Figure 4).
The abutment was returned to North Shore Dental Laboratories for fabrication of the PFM crown (see Figure 5).
The abutment and crown were returned to the prosthodontist for try-in and insertion of the Encode Abutment and PFM crown (see Figure 6).