Hiding Screw and Endo Access Holes- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is my current procedure for screw retained implant supported crowns and hiding the screw access, and also endo accesses.

Thomas W. Mitchell, DDS, FAGD
This is #19 a Strauman bone level 4.8 with as big of a healing cap that's available. The implant was placed in February 2018 with the healing cap in place.
Thomas W. Mitchell, DDS, FAGD
Since the healing cap has been in place for 6 months the tissue is very healthy. When implants are placed under tissue and then uncovered, I allow at least 4 weeks for tissue healing before the impression.
Thomas W. Mitchell, DDS, FAGD
This is a Strauman Etkon Ti custom abutment. The margins are about 1/2 mm below the top of the tissue. At this point I've torqued the screw to about 20 ncm's.
Thomas W. Mitchell, DDS, FAGD
We adjusted the PFM crown's proximal and occlusal contacts and are ready to bond the crown to the abutment. We filled the screw access in the abutment with Teflon tape and applied a ring of WO Anchor dual cure composite cement to the crown. Then seated it on the abutment clinically and allowed about 10 minutes for it to set. Many of these crowns will fit a bit loosely on the abutment. In my prior technique I bonded the crown to the abutment out of the mouth, but that little bit of rotation will change the way the unit fits back on the implant and force you to start over. Then you'll be sending the crown back to the lab to bake the cement out of the unit.
Thomas W. Mitchell, DDS, FAGD
We removed the unit and you can clearly see that, even with the Wadwani cementation technique we get some cement extruded past the margins. One of the advantages of the screwmentation technique is that now cleaning that off is simple.
Thomas W. Mitchell, DDS, FAGD
Nice clean margins and ready to go back on the implant for final torqueing to 35 ncm's.
Thomas W. Mitchell, DDS, FAGD
After final torqueing to 35 ncm's we filled the bottom of the screw access hole with Teflon tape to protect the screw head
Thomas W. Mitchell, DDS, FAGD
Then cleaned the surface with Clean and Boost and let Interface dwell for 10 seconds, dry, 2 coats Surpass 2, 1 thin coat of Surpass 3, and a thin layer of Titan WO Flowable composite to mask out the darkness of the access hole. Cured that for 10 seconds.
Thomas W. Mitchell, DDS, FAGD
Then a final layer of Exquisite Restoration composite and the screw access disappears. The crown on 18 is an older screwmented implant supported crown (just a bit more difficult due to location).

Conclusion: 

The same masking technique works for endo access holes as well. Using Interface to prepare the porcelain for bonding is much easier and safer than any of the stronger acids. Hope this helps

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

info@thomasmitchelldds.com