Can anyone ID this impression coping?

[Brett Hansen CDT]

I am trying to pour up a model for a 3.5mm Zimmer implant case, but the impression coping the doc sent me is not a Zimmer impression coping. It seats in the implant analog just fine, but the screw from the impression coping does not thread into the analog smoothly. It is even the same metallic green color as the analog, but I can't figure out where it came from.






Sorry about the picture quality...I think I need to spend some time in that area of this forum.

 

[MasterCeramist]

Could be an impression coping from one of the companies that make compatible parts for many different implants like Implant Direct etc. There might be a problem with the screw or maybe the analog has a problem. Try a new screw in your model analog or the screw that they sent in a different analog and see how things go.

 

[Brett Hansen CDT]

I put a zimmer screw in the analog and it fits fine. I can't remove the screw inside the impression coping. I am assuming it is from a co. like Implant Direct. I would just like to know which one if possible. Google failed me this time.

 

[doug]

What did the doc tell you? He's gonna be responsible for the case, right?

 

[Jo Chen]

If you push the bottom of the screw towards the impression coping body and unscrew while you push, does the screw come out?

 

[aabregini]

I think that impression post is for the UCLA PRIMA CONNEX ABUTMENTS . ITS A HEXED FOR SINGLE UNITS. It will help fit the zimmer hexed ,
but wrong impresion post.

 

[Brett Hansen CDT]

Jo, it does not unscrew smoothly at all.

Back story on this case:

Doc sends me this case a month ago. The oral surgeon had already placed a solid "anatomical" Zimmer abutment in the patient's mouth. We made a crown on the abutment with e.Max. The case came back because the restorative doc couldn't get the crown to seat. We remade it and it came back again with the same problem. She also sent a x-ray with the remake this time. Looking at the x-ray, the crown was 2mm from seating.

I knew that the abutment I was given wasn't ideal. The abutment was placed in "backwards" with the shorter collar height on the lingual and the taller collar height on the buccal. The margins of the abutment were still 2-4 mm below the gingival crest. I also hate working on Zimmer's solid abutment system. They use a plastic analog that I am supposed to make a nice margin on.

I have usually been hesitant to call a doc and tell them that they need a new abutment. When I was less experienced with implants, I was afraid to open up my lab to potential liability from one of my suggestions not working out. I am much more experienced now and should have called the doctor when I got the case the first time to let her know that the abutment I was sent was not adequate to restore this patient's smile.

So last week I called the doc and told her what I didn't like about the Zimmer abutment I was sent. She agreed with me and asked me how I would have handled the case. I told her that if it was my mouth, I would have gone with a custom abutment due to the ligualized placement of the implant and the because the implant was placed so deep sub-gingivally. I was surprised when she said that she would go that route and pay for the extra cost of the abutment out of pocket.

Then I get the new implant level impression with that impression coping above. Grrrrrrr. The Zimmer rep supplied her with that part, but he and Zimmer and have been no help in explaining to me where it came from because it isn't theirs. Luckily, the doc sent me the original metal "anatomical" abutment. I went ahead and poured up the new model with the above imp. coping. Then I screwed in the Zimmer abutment and it was a perfect match to the old model we were working on so I was confident that the new model's analog matched the implant in the patient's mouth.

I should get the Atlantis custom abutment back today for this case.

Going forward, I am going to be more proactive about calling docs and letting them know my opinions. The other positive to come out of this case is that this doc is no longer going to let the oral surgeon pick out her abutments, I will be doing that now.

 

[Jo Chen]

Brett,
I concur, Zimmer abutment level impressions over the esthetic abutments are not very good due to the plastic analog. Abutment level impressions are my least favorite because you have to work around a lot of issues. You are absolutely right, the surgeon should not place an abutment, let the lab decide what works best. Don’t be shy to tell your restorative guys, this is a service you offer to achieve the best possible result. You probably see more implant cases than the average restorative Dr. You have most likely more experience than they do and you know what would work best. Charge mark up on any parts you order.
Good luck and keep up the good work.

 

[Brett Hansen CDT]

And now the rest of the story:

I called the Doc last week to find our how the placement of the Atlantis custom abutment and new crown went. She was very happy. She said that the abutment was a bit hard to place because it displaced alot of tissue on the facial side of the abutment, but that she also saw that it was needed to create a natural looking crown. She just numbed up the patient and was able to place the abutment. She told me that she informed her oral surgeon not to provide abutments for her patient's cases anymore and that she will be taking implant level impressions and sending them to me to choose the best options for restoring any implant cases in the future. I love it when a plan comes together.