Prevent Retention of Cement

For bone-level implants after osteointegration, choose or keep a proper abutment, confirm its seating with intraop X-ray (Fig.9), prepare if necessary and take impression without torqueing.  Ask the lab to fabricate a crown with occlusal access hole (diameter to be measured against one in the abutment).  Try in the crown intraorally with attention to proximal contact.  Remove Cavit and cotton pellet and place a long piece of new cotton pellet in the access hole of the abutment, tall enough to extend into the access hole of the crown.  Place a cement evenly in the inner surface of the crown and seat the latter completely.  Remove the excess cement from the crown access hole while the cement is setting.  After cement setting, remove the crown/abutment unit and remove the excess cement at the junction of the crown/abutment, particularly proximally.  Torque the abutment screw while checking whether the abutment/crown complex turns.  Place a long piece of cotton pellet in the complex access hole lightly, seal initially with flowable and then packable composite.  Adjust occlusion and check contact again. 

A 2nd advantage of this method is that the crown is retrievable for repair.

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Xin Wei, DDS, PhD, MS 1st edition 08/04/2016, last revision 08/04/2016