Rotated abutment

[macminn]

We have had another abutment rotated in the mouth. On the model it's great, but it's turned in the mouth. The doc swears he had the transfer post down all the way, blah, blah, blah.

Does anyone have a protocol, or other suggestions that I can give this doc?

 

[CatamountRob]

Verify with an x-ray?

 

[rkm rdt]

I've had that happen with Biohorizons. I bet it was a closed impression coping.

I would suggest switching to an open tray coping that is locked in the impression.

 

[Jo Chen]

Rob's advice to ask for an x-ray of the seated impression copig is sound advice. The person repositioning the indirect impression coping with the attached analog in to the impression needs to be carefull. If the Dr. sent the impression coping/analog assembly already seated in the impression, take it out and reposition it again. Adding a little water to the impresion coping when seating makes things a little smoother. Some implant brands are easier than others. Nobel Replace is easy compared to Implant Direct Legacy.

 

[prostho]

Seen this several times also. Rotating is different than not seating. If the impression coping is not seated before the impression, it will not be at the correct vertical height and may also be rotated. If at the correct vertical height and only rotated, it is seated but the impression coping was not positioned in the impression the right way. The only real way to be sure what happened is to take a new impression and compare the two models. If different vertical height the doctor did may not have it seated. If just rotated then the lab did not re-position the impression coping correctly.

open tray impression eliminates this. If the doctor insists on a closed tray suggest a more rigid PVS impression or a Poly ether impression to allow a more accurate and rigid positioning of the impression coping back in the impression.

Many impression copings (nobel replace, nobel conical) will not allow the impression coping to engage or screw in at all unless they are seated so many doctors feel it is not necessary to take an xray to verify seating of the impression coping, Each system is different and you just have to try the impression coping on the analogue to see if is possible to engage the screw without the hex or trilobe engaging.

Last possible cause is that the implant is not integrated and in fact rotated after the impression was taken, yes I have seen this happen

 

[Sevan P]

Verify with an x-ray?

This is the only way they can verify before impressioning.

 

[Brett Hansen CDT]

What implant system is this? I always remove the impression coping if it comes already placed in a closed tray impression. Definitely make sure the doc is using a rigid impression material. The only implant system I have encountered where this has been an issue on a semi-regular basis is with Southern. They are a clone of Nobel Replace, except they didn't clone Nobel's impression copings. The retention on these impression copings is not adequate, especially for the 3.5mm platform. They have since redesigned them to add retention. A couple of things I used to do was to use a black Sharpie and make a mark right above the middle of the flat side of the impression coping on the impression and do the same on the impression coping down onto the analog. This would help confirm that I had it orientated correctly. Another thing I started doing was modifying a batch of impression copings with my hand piece to add more retention.

As others have said, an xray of the seated impression coping is always a good idea to confirm that the doctor's office got it seated correctly in the mouth.

 

[primus]

Probably Tri-Lobe...someone removed impression pick_up thingy and replaced it in wrong position.

Could be labs fault, or could be docs fault. Someone did it.....?

 

[Marcusthegladiator CDT]

Ug, i hate closed tray BS. What do they think is gonna happen? The chances of an impression coping for a closed tray rotating are 10,000X greater than an open trays coping.
DOWN WITH CLOSED TRAY!! DOWN WITH CLOSED TRAY! DOWN WITH LAZY TECHNIQUES!!!
And then the lab rebuilds it for free...

 

[lcmlabforum]

Don't thrash the technique, sometimes you may have to use it when the implants
are angled in a unfavorable way an basket that has a pick up is the only way to
do this because the guide pin or screw will run into each other . . .
Many ways to skin a cat - I like and use open tray, implant level 99% of the
time but need to always keep your options open . . .
Just my 2 cents.
LCM

 

[Marcusthegladiator CDT]

Don't thrash the technique, sometimes you may have to use it when the implants
are angled in a unfavorable way an basket that has a pick up is the only way to
do this because the guide pin or screw will run into each other . . .
Many ways to skin a cat - I like and use open tray, implant level 99% of the
time but need to always keep your options open . . .
Just my 2 cents.
LCM

COuldnt the doc find a way with a smaller right angle/flex driver?

 

[lcmlabforum]

Well, I am the 'doc' (prosthodontist) here and the implant
level impression posts screws crossed each other.
Straumann impression post for open tray stick out a bunch
and I did not want to cut it down and make a slot. Pt has
34mm opening at the incisal edges as it was.
Cannot open for more than a few minutes at a time.
LCM