implant maintenance presentation

Implant Maintenance and RepairImplant Maintenance and Repair

Implant Maintenance and RepairImplant Maintenance and Repair

• The purpose of this presentation is to provide the basic The purpose of this presentation is to provide the basic knowledge to perform proper maintenance and minor knowledge to perform proper maintenance and minor repairs to patients that have been restored with dental repairs to patients that have been restored with dental implants.implants.– Slides 1 thru ## are a basic introduction providing essential Slides 1 thru ## are a basic introduction providing essential

information when performing an evaluation on an implant information when performing an evaluation on an implant patient.patient.

– Slides ## to ## identify the materials and methods to performing Slides ## to ## identify the materials and methods to performing proper maintenance check - ups.proper maintenance check - ups.

– Slides ## to ## describe clinical situations that may present Slides ## to ## describe clinical situations that may present themselves. Diagnosis through treatment is emphasized.themselves. Diagnosis through treatment is emphasized.

Implant - Soft Tissue InterfaceImplant - Soft Tissue Interface

• Normal gingival architectureNormal gingival architecture

• Minimal inflammatory Minimal inflammatory infiltrateinfiltrate

• Connective tissue closely Connective tissue closely adapted to the implantadapted to the implant

HealthyHealthy

Bone MaturationBone Maturation

• Pre-existing bone (PB) extends into Pre-existing bone (PB) extends into threads providing stability.threads providing stability.

• New Bone (NB) in close apposition to the New Bone (NB) in close apposition to the implantimplant

• New Bone deposition approximately New Bone deposition approximately 1um/day1um/day

NB

PB

OsseointegrationOsseointegration

• Dynamic processDynamic process

• Healing phase: 0 - 12 monthsHealing phase: 0 - 12 months

• Remodeling phase: 3 - 18 monthsRemodeling phase: 3 - 18 months

• Steady state: 18 months ---Steady state: 18 months ---

OsseointegrationOsseointegrationa dynamic processa dynamic process

Implant fixtureImplant fixture

AbutmentAbutment

Retaining screwRetaining screw

Abutment screwAbutment screw

Components of an Components of an implant restorationimplant restoration

Composite resinComposite resin

- Screw retained implant - Screw retained implant restorations consist of three restorations consist of three components.components.

(a) implant fixture(a) implant fixture

(b) abutment(b) abutment

(c) restoration(c) restoration

- the abutment screw secures the - the abutment screw secures the abutment to the fixtureabutment to the fixture

- the prosthetic retention screw - the prosthetic retention screw secures the prosthesis to the secures the prosthesis to the abutment.abutment.

Gutta perchaGutta percha

AbutmentAbutment

Abutment screwAbutment screw

AbutmentAbutment

- can be either parallel (standard) - can be either parallel (standard) or conical (estheticone) in shape.or conical (estheticone) in shape.

- are secured with an abutment - are secured with an abutment screw that is tightened to 20 Ncm.screw that is tightened to 20 Ncm.

(Screw retained restoration)(Screw retained restoration)

AbutmentAbutment(Cemented restoration)(Cemented restoration)

- Cera One abutment- Cera One abutment

- secured with a square head - secured with a square head screw tightened to 32 Ncm.screw tightened to 32 Ncm.

(green)(green)

(red)(red)

Retaining screwRetaining screw

Prosthetic retaining Prosthetic retaining screwscrew

- can have a slot or hex head- can have a slot or hex head

- access is usually covered by a - access is usually covered by a combination of gutta percha combination of gutta percha and composite.and composite.

- used to retain the prosthesis - used to retain the prosthesis to the abutment.to the abutment.

- tightened to 10 Ncm.- tightened to 10 Ncm.

Hand Screw DriversHand Screw Drivers

Prosthetic retention Prosthetic retention slotslot screw driver screw driver

Prosthetic retention Prosthetic retention hexhex screw driver screw driver

HexHex Abutment driver Abutment driver Standard and conical (estheticone)Standard and conical (estheticone)

SquareSquare abutment driver abutment driverCera One or Cera One or squaresquare abutment screws abutment screws

Slot Screw DriverSlot Screw Driver

- Used to remove or replace slotted prosthetic retention screws.Used to remove or replace slotted prosthetic retention screws.

- Tighten to 10 Ncm- Tighten to 10 Ncm

Hex Screw DriverHex Screw Driver

- Used to remove or replace hex prosthetic retention screws.Used to remove or replace hex prosthetic retention screws.

- Tighten to 10 Ncm.- Tighten to 10 Ncm.

Abutment Screw DriverAbutment Screw Driver

- Used to remove or replace abutment screws for standard or - Used to remove or replace abutment screws for standard or conical (estheticone / mirus cone) abutments.conical (estheticone / mirus cone) abutments.

- Tighten to 20 Ncm.- Tighten to 20 Ncm.

Square Screw DriverSquare Screw Driver

- Used to remove or replace Cera One abutment screw.- Used to remove or replace Cera One abutment screw.

- Tighten to 32 Ncm- Tighten to 32 Ncm

Maintenance and RecallMaintenance and Recall• AnnuallyAnnually

– periapical radiographs should be taken to monitor the crestal bone levels. (crestal bone can periapical radiographs should be taken to monitor the crestal bone levels. (crestal bone can be at the level of the first thread in one year with 0.1mm continued loss to approximately 1. 5 be at the level of the first thread in one year with 0.1mm continued loss to approximately 1. 5 mm total bone loss)mm total bone loss)

– remove and reinsert screw retained implant prostheses every 2 years unless indicated remove and reinsert screw retained implant prostheses every 2 years unless indicated otherwise.otherwise.

• Replace prosthesis with new retaining screws if removed.Replace prosthesis with new retaining screws if removed.

– Cemented restorations are usually permanent (nonretrievable).Cemented restorations are usually permanent (nonretrievable).

– Recall focusRecall focus• OcclusionOcclusion - verify there are no excursive contacts. Should not hold shimstock. Better to be out of - verify there are no excursive contacts. Should not hold shimstock. Better to be out of

occlusionocclusion• Oral hygieneOral hygiene - same requirements as for natural teeth. - same requirements as for natural teeth.• Soft tissue healthSoft tissue health - periodontal probing for evidence of disease. - periodontal probing for evidence of disease.• Screw joint torqueScrew joint torque - check for loosened screws (most common problem). - check for loosened screws (most common problem).• Integrity of attachmentsIntegrity of attachments - applies to overdenture / overpartials. - applies to overdenture / overpartials.• Stability of implantsStability of implants - must be stable (non mobile) to be successful - must be stable (non mobile) to be successful

Maintenance and RecallMaintenance and Recall

• Screw retained prosthesisScrew retained prosthesis– Remove prosthetic retention screwsRemove prosthetic retention screws

• Screw access holes are usually sealed with a layer of cotton pellet, silicone plug or gutta Screw access holes are usually sealed with a layer of cotton pellet, silicone plug or gutta percha the acrylic or composite resin.percha the acrylic or composite resin.

• Expose the screw by drilling carefully through the resin.Expose the screw by drilling carefully through the resin.• Remove the screw (slot or hex) with the appropriate screw driver.Remove the screw (slot or hex) with the appropriate screw driver.• Throat drapes are highly recommended.Throat drapes are highly recommended.

– Check for implant mobility and retorque abutments to 20 Ncm. (hand tighten as Check for implant mobility and retorque abutments to 20 Ncm. (hand tighten as much as possible with finger abutment driver if no torque control device is available)much as possible with finger abutment driver if no torque control device is available)

– Clean and polish abutments Clean and polish abutments (Do not remove)(Do not remove)

– Reseat restoration using Reseat restoration using newnew gold retaining screws. gold retaining screws.• Tighten screws as if doing nuts on the lugs of an automobile - place all screws back with Tighten screws as if doing nuts on the lugs of an automobile - place all screws back with

minimal torque. Then work back and forth across the arch until all are tightened to 10 minimal torque. Then work back and forth across the arch until all are tightened to 10 Ncm. (hand torque with appropriate hand screw driver if no torque controller is available)Ncm. (hand torque with appropriate hand screw driver if no torque controller is available)

Maintenance and RecallMaintenance and Recall

• Screw retained prosthesis (cont.)Screw retained prosthesis (cont.)– Temporary reinsertionTemporary reinsertion

• fill access holes with small cotton pellet and polyvinylsiloxane impression material or fill access holes with small cotton pellet and polyvinylsiloxane impression material or putty.putty.

– Long-term reinsertionLong-term reinsertion• fill access hole with small cotton pellet over the head of the screw, followed by warm fill access hole with small cotton pellet over the head of the screw, followed by warm

gutta percha and only 1-2 mm of acrylic or composite resin.gutta percha and only 1-2 mm of acrylic or composite resin.

• Cemented restorationsCemented restorations– Single unitSingle unit

• usually nonretrievable and not removed for maintenance.usually nonretrievable and not removed for maintenance.

– Multiple unit Multiple unit (usually not indicated)(usually not indicated)• carefully tap off with crown remover, check for mobile implants and retorque abutment carefully tap off with crown remover, check for mobile implants and retorque abutment

screws.screws.• Replace restoration with provisional luting media, and recheck occlusion.Replace restoration with provisional luting media, and recheck occlusion.

Hygiene AidsHygiene Aids

• Super - flossSuper - floss

• End tufted brushesEnd tufted brushes

• Proxy brushesProxy brushes

• Tarter control dentrificesTarter control dentrifices

• Mechanical instrumentsMechanical instruments

• PeridexPeridex

Super - FlossSuper - Floss

- Excellent for all types of - Excellent for all types of implant restorationsimplant restorations

Butler Post Care Floss AidButler Post Care Floss Aid

- Excellent for implant - Excellent for implant bars and fixed hybrid bars and fixed hybrid prostheses.prostheses.

Fixed Hybrid Prosthesis

- Hygiene care with a proxy brush

Soft Tissue RelationshipSoft Tissue Relationship

• Similar to teethSimilar to teeth

• No Sharpeys fibersNo Sharpeys fibers

• Hemidesmosomal Hemidesmosomal attachmentsattachments

• Circumferential and Circumferential and perpendicular perpendicular connective tissueconnective tissue

Plastic probes are used when Plastic probes are used when checking for evidence of disease.checking for evidence of disease.

Implants are similar to Implants are similar to the natural tooth.the natural tooth.

Implantitis vs. Periodontal disease Implantitis vs. Periodontal disease have similar clinical presentationshave similar clinical presentations

Patient presents with a maxillary RPD with an implant Patient presents with a maxillary RPD with an implant bar/clip component to the anterior edentulous area.bar/clip component to the anterior edentulous area.

(next slide)(next slide)

Butler Floss Aid is used to Butler Floss Aid is used to clean the bar including the clean the bar including the area contacting the tissue.area contacting the tissue.


The bar may be removed with the appropriate The bar may be removed with the appropriate screw driver, polished and the torque of all the screw driver, polished and the torque of all the abutments checked prior to replacement.abutments checked prior to replacement.

Prophy paste and a rubber cup Prophy paste and a rubber cup on a prophy head / handpiece can on a prophy head / handpiece can be used to polish implant bars be used to polish implant bars when removal is not indicatedwhen removal is not indicated

Plastic scalers are appropriate Plastic scalers are appropriate for cleaning around standard for cleaning around standard abutments supporting abutments supporting implant bar substructures, implant bar substructures, hybrid prostheses and implant hybrid prostheses and implant supported splinted supported splinted restorations.restorations.

Plastic scaler tips are also Plastic scaler tips are also available for metal handle available for metal handle scalers.scalers.

Implant supported fixed partial denture

Scaler tips are designed to fit the curvature of the standard abutment.

Problems in the fieldProblems in the field

• Fractured/loosened screwsFractured/loosened screws

• Fixture lossFixture loss

• Poor oral hygienePoor oral hygiene

• Soft tissue reactionsSoft tissue reactions

• Broken attachmentsBroken attachments

• Fractured componentsFractured components

Fractured or loosened screwsFractured or loosened screws

• Usually results in localized inflammation, loose restorations and Usually results in localized inflammation, loose restorations and discomfort.discomfort.– First suspicion when patient complains of discomfort or loose implant.First suspicion when patient complains of discomfort or loose implant.

• Prosthetic gold retaining screws have either a slot or hex head.Prosthetic gold retaining screws have either a slot or hex head.• Abutment screws require a hex abutment driver, large slot, hex or square Abutment screws require a hex abutment driver, large slot, hex or square

driver.driver.– Standard and conical (estheticone) abutments have a raised hex and require a wrench Standard and conical (estheticone) abutments have a raised hex and require a wrench

that fits over this hex.that fits over this hex.

– All other abutment screws have the slot, hex or square depression inside the screw All other abutment screws have the slot, hex or square depression inside the screw head.head.

• Loose single tooth abutments are Loose single tooth abutments are true emergenciestrue emergencies. Continued rotation . Continued rotation can risk rounding the corners of the hex on the implant, causing a loss in can risk rounding the corners of the hex on the implant, causing a loss in anti-rotation.anti-rotation.

Tissue appears swollen and edematous

Multiple areas exhibit poor tissue response.

Diagnosis:

– Possible loose or fractured abutment screw

Radiographic evaluation to determine treatment.

Radiographic evaluation of a Radiographic evaluation of a loose healing abutment.loose healing abutment.

Removal of healing Removal of healing abutment indicates a abutment indicates a distorted screwdistorted screw

TreatmentTreatment::

Replace with new healing Replace with new healing abutmentabutment

Initial PresentationInitial Presentation: : Loose Healing AbutmentLoose Healing Abutment

Area of Area of concernconcern

Radiograph confirms poor Radiograph confirms poor seating abutment.seating abutment.

DiagnosisDiagnosis::

- possible loose or fractured - possible loose or fractured abutment screwabutment screw

Clinical evaluation after Clinical evaluation after removal of bar indicates loose removal of bar indicates loose abutment screw.abutment screw.


1 - Retorque abutment screw.1 - Retorque abutment screw.

Initial PresentationInitial Presentation: Loose bar: Loose bar

Abutment screw driver.Abutment screw driver.

Treatment: continuedTreatment: continued

2 - Abutment screw is 2 - Abutment screw is tightened with abutment tightened with abutment driver.driver.

3 - Bar is then replaced and 3 - Bar is then replaced and prosthetic screws are torqued prosthetic screws are torqued with appropriate screw driver.with appropriate screw driver.

Clinical ExamClinical Exam: Loose restoration: Loose restoration

Radiographic EvaluationRadiographic Evaluation: Small : Small opening at abutment-implant opening at abutment-implant interfaceinterface

Small opening

DiagnosisDiagnosis::

- Loose abutment screw- Loose abutment screw


1 - Loosen screw and remove 1 - Loosen screw and remove restorationrestoration


TreatmentTreatment: continued: continued

2 - inspect the implant hex for 2 - inspect the implant hex for damagedamage

3 - inspect the restoration for 3 - inspect the restoration for damagedamage

Implant hex

Abutment hexAbutment hex

(A) No Damage to fixture of restoration(A) No Damage to fixture of restoration

4a - replace restoration and secure with 4a - replace restoration and secure with the appropriate new screw. Verify seating the appropriate new screw. Verify seating with radiograph prior to final torque. with radiograph prior to final torque. Recheck occlusion with shimstock.Recheck occlusion with shimstock.

(B) Damaged fixture hex and or restoration(B) Damaged fixture hex and or restoration

4b - replace restoration and secure with 4b - replace restoration and secure with same screw. Refer to Command Implant same screw. Refer to Command Implant Coordinator.Coordinator.

Fractured Abutment ScrewFractured Abutment Screw

Treatment PlanTreatment Plan::

1 - Remove prosthetic 1 - Remove prosthetic restoration.restoration.

2 - Remove fractured 2 - Remove fractured abutment.abutment.

3 - Remove fractured 3 - Remove fractured abutment screw.abutment screw.

- Intraoral fractured - Intraoral fractured abutment screws can often abutment screws can often be teased out with the tip be teased out with the tip of an explorer.of an explorer. (next slide)


- the tip of the explorer is - the tip of the explorer is placed on the top portion of placed on the top portion of the fractured abutment the fractured abutment screw.screw.

- with slight apical pressure - with slight apical pressure and a counterclockwise and a counterclockwise circular motion, the fragment circular motion, the fragment can often be unscrewed.can often be unscrewed.

- care must be taken not to - care must be taken not to damage the internal threads damage the internal threads of the implant. Requires of the implant. Requires extreme patience.extreme patience.


Fractured Abutment Fractured Abutment ScrewScrew

- rotary instruments have been used by - rotary instruments have been used by skilled practitioners utilizing skilled practitioners utilizing magnification. magnification. (not recommended) (not recommended)

(A) Screw Fragment removed(A) Screw Fragment removed

4a - replace with appropriate 4a - replace with appropriate new abutment and screw. new abutment and screw. Verify seating with a Verify seating with a radiograph prior to final radiograph prior to final torque.torque.

5a - replace prosthesis and 5a - replace prosthesis and secure with new retention secure with new retention screws.screws.

Treatment :Treatment : continued continued



(B) Screw fragment unable to be removed(B) Screw fragment unable to be removed

4b - Replace prosthesis on existing abutments and secure 4b - Replace prosthesis on existing abutments and secure with prosthetic retention screws or place healing caps on all with prosthetic retention screws or place healing caps on all abutments. On request Nobel Biocare will send you a tool kit abutments. On request Nobel Biocare will send you a tool kit to help retrieve broken abutment screws. (800) 891-9191. to help retrieve broken abutment screws. (800) 891-9191. Consult the Command Implant Coordinator first.Consult the Command Implant Coordinator first.

5b - Refer to Command Implant Coordinator.5b - Refer to Command Implant Coordinator.

Fixture lossFixture loss((Must differentiate between “failing” and “failed”) Must differentiate between “failing” and “failed”)

• Failing ImplantFailing Implant– Clinical signs:Clinical signs:

• progressive bone lossprogressive bone loss

• soft tissue pocketing and crestal bone losssoft tissue pocketing and crestal bone loss

• bleeding on probing with possible purulencebleeding on probing with possible purulence

• tenderness to percussion or torque forcestenderness to percussion or torque forces

– Causes:Causes:• overheating of boneoverheating of bone at the time of surgery or lack of initial stability.at the time of surgery or lack of initial stability.

• Nonpassive superstructuresNonpassive superstructures

• inadequate screw joint closureinadequate screw joint closure

• functional overloadfunctional overload

• periodontal infection (peri-implantitis)periodontal infection (peri-implantitis)

Fixture lossFixture loss

• Failing ImplantFailing Implant– Treatment:Treatment:

• Interim: remove prosthesis and abutmentsInterim: remove prosthesis and abutments– irrigate with Peridexirrigate with Peridex– ultrasonic and disinfect all componentsultrasonic and disinfect all components– reinsert assuring proper screw torquereinsert assuring proper screw torque– recheck passive fit of framework and occlusionrecheck passive fit of framework and occlusion

• Failed ImplantFailed Implant– Clinical signs:Clinical signs:

• MobilityMobility– verify fixture mobility by removing any abutments and superstructures first.verify fixture mobility by removing any abutments and superstructures first.

• A “Dull” percussion sound has been associated with a failed implantA “Dull” percussion sound has been associated with a failed implant• Peri-implant radiolucency can be a radiographic findingPeri-implant radiolucency can be a radiographic finding

– often this is not evident on an X-rayoften this is not evident on an X-ray

Fixture lossFixture loss

• Failed ImplantFailed Implant– CausesCauses

• surgical compromise (overheating bone and initial lack of stability).surgical compromise (overheating bone and initial lack of stability).

• Nonpassive superstructures.Nonpassive superstructures.

• Inadequate screw joint closureInadequate screw joint closure

• Too rapid initial loadingToo rapid initial loading

• Functional overloadFunctional overload

• Periodontal infection (“peri-implantitis”)Periodontal infection (“peri-implantitis”)

– TreatmentTreatment• removal of the implantremoval of the implant

Presentation: Lost restoration

Radiographic evaluationRadiographic evaluation: fractured : fractured fixturefixture


1 - refer to Command Implant Coordinator.1 - refer to Command Implant Coordinator.

2 - eventual implant removal2 - eventual implant removal

Diagnosis: Fractured implant fixture head

Oral HygieneOral Hygiene

• calculus build up can cause calculus build up can cause areas of soft tissue areas of soft tissue inflammation.inflammation.• may result in progressive bone may result in progressive bone loss if left untreated.loss if left untreated.

TreatmentTreatment

• remove prostheses, check remove prostheses, check implants for mobility, retorque implants for mobility, retorque abutments.abutments.• perform maintenance cleaning perform maintenance cleaning on prosthesis and abutments.on prosthesis and abutments.

• reinsert prosthesis with new reinsert prosthesis with new screws, give oral hygiene screws, give oral hygiene instructions.instructions.

Soft tissue reactionsSoft tissue reactions

• Often seen with split thickness skin grafts or lack of Often seen with split thickness skin grafts or lack of periabutment keratinized tissueperiabutment keratinized tissue

• Soft tissue inflammation most commonly due to loose screw Soft tissue inflammation most commonly due to loose screw joints.joints.– Remove the offending screws, tighten the abutments and reinsert the Remove the offending screws, tighten the abutments and reinsert the

prosthesis.prosthesis.

• Poor oral hygiene: soft tissue inflammation often referred to Poor oral hygiene: soft tissue inflammation often referred to “peri-implantitis”. Etiology similar to natural teeth (plaque, “peri-implantitis”. Etiology similar to natural teeth (plaque, lack of attached tissue, etc.) May result in progressive bone loss.lack of attached tissue, etc.) May result in progressive bone loss.

• Failing or failed implants.Failing or failed implants.

PresentationPresentation: Soft tissue : Soft tissue reactionreaction

Radiographic evaluation:

(A) Within Normal Limits(A) Within Normal Limits (B) Loose or fractured screw(B) Loose or fractured screwTreatmentTreatment::

1 - See treatment for loose or 1 - See treatment for loose or fractured screwsfractured screws


1 - Remove abutment1 - Remove abutment

2 - Irrigate area with sterile 2 - Irrigate area with sterile saline or Peridex (next slide)saline or Peridex (next slide)

TreatmentTreatment: (cont): (cont)

3 - Replace abutment or restoration.3 - Replace abutment or restoration.

4 - Follow up as needed4 - Follow up as needed

Irrigate area with Irrigate area with sterile saline or sterile saline or peridex.peridex.

Broken AttachmentsBroken Attachments

• Plastic bar clipPlastic bar clip– damaged or brokendamaged or broken

• cut along long axis with sharp knife and remove.cut along long axis with sharp knife and remove.

– MissingMissing• replace by inserting a new clip into denture base receptaclereplace by inserting a new clip into denture base receptacle• if unavailable, contact Command Implant Coordinatorif unavailable, contact Command Implant Coordinator

• Metal bar clipMetal bar clip– damaged or broken damaged or broken (replacement clip available)(replacement clip available)

• remove the clip and perforate the denture base carefully for intraoral pick up replacement.remove the clip and perforate the denture base carefully for intraoral pick up replacement.• Block out under the bar with wax, seat the denture and position a new clip through access Block out under the bar with wax, seat the denture and position a new clip through access

in denture base.in denture base.• Use autopolymerizing acrylic resin with “bead brush” technique to fill in access and connect Use autopolymerizing acrylic resin with “bead brush” technique to fill in access and connect

clip to denture base. Polish , disinfect and deliver.clip to denture base. Polish , disinfect and deliver.• Always confirm seating of denture after repair and evaluate occlusion.Always confirm seating of denture after repair and evaluate occlusion.

Broken AttachmentsBroken Attachments

• Metal bar clipMetal bar clip– Damaged or broken Damaged or broken (replacement clip not available)(replacement clip not available)

• remove all remnants of the clip from the denture base.remove all remnants of the clip from the denture base.

• block out under the bar with waxblock out under the bar with wax

• reline the clip area of the denture with a resilient chairside reline material (viscogel).reline the clip area of the denture with a resilient chairside reline material (viscogel).

– Intact clip with no retentionIntact clip with no retention• carefully bend the leaves of the clip toward the bar with a thin instrument.carefully bend the leaves of the clip toward the bar with a thin instrument.

• Reseat the denture to confirm increased retention.Reseat the denture to confirm increased retention.

• Recheck occlusion.Recheck occlusion.

• Stud attachmentsStud attachments– treatment is similar to clipstreatment is similar to clips

• tease out “O” ring with an explorer and replace as needed.tease out “O” ring with an explorer and replace as needed.

• Fractured housing can be treated like a clip replacement.Fractured housing can be treated like a clip replacement.

Lost clipLost clip

Clip RepairClip Repair

1 - Block out bar with wax1 - Block out bar with wax

2 - Remove all remnants of 2 - Remove all remnants of the clip from the denture the clip from the denture base.base.

3 - reline clip area of denture 3 - reline clip area of denture with resilient chairside reline with resilient chairside reline material. (Viscogel)material. (Viscogel)

Clip RepairClip Repair

4 - Reseat prosthesis and 4 - Reseat prosthesis and verify occlusion.verify occlusion.

5 - Remove after 10 to 15 5 - Remove after 10 to 15 minutes, trim excess minutes, trim excess material, polish, disinfect material, polish, disinfect and deliver back to patient.and deliver back to patient.

3 - reline clip area of 3 - reline clip area of denture with resilient denture with resilient chairside reline material. chairside reline material. (Viscogel)(Viscogel)

Fractured componentsFractured components

• Screw retained prosthesisScrew retained prosthesis– Fractured resin or prosthetic tooth Fractured resin or prosthetic tooth

• remove prosthesis and repair as if a conventional prosthesis.remove prosthesis and repair as if a conventional prosthesis.• If the prosthesis is a hybrid, remove in the same manner as for a maintenance If the prosthesis is a hybrid, remove in the same manner as for a maintenance

appointment.appointment.

• Cemented ProsthesisCemented Prosthesis– Multiple unit restorationMultiple unit restoration

• carefully tap off the restoration with crown remover and repair as indicated.carefully tap off the restoration with crown remover and repair as indicated.

– Single unit restorationSingle unit restoration• if no screw access, drill an access through the occlusal surface to the abutment if no screw access, drill an access through the occlusal surface to the abutment

screw and remove the restoration.screw and remove the restoration.• Repair or fabricate provisional as indicated.Repair or fabricate provisional as indicated.

implant maintenance presentation

Documents

abutment screw driver

screw prosthetic

recall screw

screw slot

hex screw driver

slot screw driver

appropriate screw driver

square screw driver