Anterior Implant Technique Using Custom Transfer Assemblies

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Anterior Implant Technique Using Custom Transfer
Assemblies
Presented by Peter G. Lemieux, DMD
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Considerations for Success

• Implant Placement
• Position
• Angulation
• Smile Elements
• Gingival Display
• Ridge Morphology
• Soft Tissue Development

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Considerations for Success

• Determinants of Papillary Height
• Underlying bone
• Volume of gingival embrasure
• Patients biologic width
• How can we predictably create and influence ideal
  soft tissue contours, and then relate these
  contours effectively to our labs for crown
  fabrication?

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Before and After Photos
Case 1
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Before and After Photos
Case 2
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Before and After Photos
Case 3
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Developing the Provisional Crown

• 1. Use wax-up to create provisional crown matrix.
• 2. Remove healing cap and insert a temporary
  abutment.
• Metal
• or Plastic

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Developing the Provisional Crown

• Clearfil OPAQUER

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Developing the Provisional Crown

• 3. Reduce abutment to fit within provisional
  matrix.
• 4. Fabricate rough provisional over abutment and
  gain access to abutment screw.

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Developing the Provisional Crown

• 5. Remove provisional and attach to implant
  analog.
• 6. Recontour provisional, use composite material
  to develop ovate intaglio surfaces, and polish.

Case 1
Case 2
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Developing the Provisional Crown
Developing Tissue Form
9. Allow adequate time for tissue to develop.
(at least 3 months)

• 7. Place provisional into mouth and redefine
  contacts and contour.
• 8. Hand tighten abutment screw, and cover with
  cotton pellet and body shade composite material.

Case 1
Case 2
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Developing Tissue Form

• 10. Remove provisional and evaluate tissue.

Case 1
Case 3
Case 2
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Developing Tissue Form
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Developing Custom Transfer Assembly

• 11. Place provisional crown onto implant analog.
• 12. Insert provisional into putty or stone and
  allow to set.

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Developing Custom Transfer Assembly

• 13. Remove provisional and place an open or
  closed tray transfer assembly onto implant
  analog.
• 14. Apply flowable composite material or Duralay
  resin around transfer assembly and cure.

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Developing Custom Transfer Assembly

• 15. Remove custom transfer assembly and trim away
  any flash.

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Fixture Level Impression

• 16. Seat custom transfer assembly onto implant
  and impress for final restoration.
• 17. Remove impression tray, remove custom
  transfer assembly, attach an implant analog, and
  seat assembly into impression for pour up.

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Finished Results

• 18. Instruct lab to pour up a soft tissue model
  and create crown to support tissue.

Case 1
Case 2
Case 3
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• The End