The initial scan produced images called point clouds (Figure 9). Point clouds consist of thousands of individual data points that were converted to a virtual computer model called a “solid model.” The scan of the Encode® Healing Abutment cast interpreted the codes for the abutment design. The scan was of healed soft tissue around the Encode Healing Abutment, therefore, the margins of the abutment were accurately postioned. On this solid model, a patient-specific virtual abutment was designed (Figures 10-12). This information was transferred to the milling machine for fabrication of the Encode Final Abutment from a solid blank of titanium alloy.

The Final Encode Abutment was treated with a gold colored Titanium Nitride coating to provide a warm hue to the abutment through the soft tissue at the gingival margin. The abutment was returned to the commercial dental laboratory for placement on the master cast and fabrication of the definitive PFM crown (Figures 13-15). The Final Encode Abutment and crown were returned to the restorative dental office for try-in and insertion. A hexed Gold-Tite® Abutment Screw used to secure the abutment to the implant, was torqued to 20Ncm with a Restorative Torque Indicator (Figures 16 and 17) and the definitive crown was cemented to the abutment with TempBond® Temporary Cement (Kerr Corporation, Orange, CA) (Figure 18).

DISCUSSION

The level of the interproximal height of bone to a dental implant is related to many different factors, primarily the location of the junction between the implant and abutment. In external hex implants, the junction extends to the lateral edge of the implant and generally, bone remodeling occurs approximately 2mm apical to the Implant-Abutment Junction (IAJ). Bone remodeling around implants occurs within 6 to 8 weeks after exposure to the oral cavity, with either one-or two-stage protocols. The level of interproximal bone loss in external hex implants may be decreased by a process known as Platform Switching, where an abutment with a restorative platform smaller in diameter than the implant platform is placed at the time the implant is exposed to the oral cavity. The Certain® PREVAIL® Implant has Platform Switching built into its design, which puts the IAJ in an ideal position (Figure 19). The location of the IAJ has been changed and is now located inside the platform of the implant; the location of the interproximal height of bone for the Certain PREVAIL Implant can be occlusal to the location of interproximal bone for external hex implants that do not incorporate Platform Switching. This may become critically important in clinical cases where short implants are placed to maximize the height of bone available for bone-to-implant contact above the inferior alveolar nerve or under the maxillary sinus; or in the aesthetic zone.