All-In-One IPS e.max Abutment Crown

An ideal implant restoration would be natural looking, have great strength, and be screw retained. In the past, the most common option was a PFM screw retained implant crown. Although this was strong and screw retained, it was not consistently natural looking due to the metal framework underneath. To achieve the natural cosmetics with implants it required custom zirconium abutments with a porcelain restoration cemented to it. This is still a great option, but requires a higher skill level and can be time consuming for the average dentist. And it does not provide a screw retained option to retrieve the restoration.  

IPS e.max® lithium disilicate (Ivoclar Vivadent; Amherst, N.Y.) has produced a paradigm shift in implant restorations. It gives the restorative dentist an option to restore a screw retained implant restoration with natural esthetics and strength. IPS e.max® has already become a leading ceramic option in conventional crown and bridge cases. It has a high flexural strength (400 MPa) and since there is no veneering porcelain there is little to no risk of porcelain fracture. IPS e.max® has a variety of shades with varying translucencies. Lab technicians can further characterize the restoration with staining and glazing as needed.  

A vital part in the esthetics of implant restorations is the proper development of the emergence profile. A soft tissue model is imperative in order to create the emergence profile on implant restorations. The typical stock abutment does not allow the restoration design to have an emergence profile because it has a cylindrical design. A proper emergence profile can easily be designed and fabricated with a custom abutment as well as a screw retained implant restoration.  

After checking for proper occlusion and proximal contacts on the restoration intraorally, the final IPS e.max abutment is cemented onto a titanium base abutment extraorally. There is no need to cement the restoration intraorally, which is one of the leading causes of cement sepsis and implant failure due to the incomplete removal of cement. The excess cement is then removed and polished in the laboratory. The all-in-one screw retained IPS e.max abutment and crown is then torqued down. The screw access is covered with Teflon tape and then a matching resin composite fills the access hole.

This all-in-one IPS e.max abutment crown is ideal for most posterior implants. It can be used in the anterior regions depending on the placement of the implant and the angle of the screw access.   Other benefits include a reduced cost for laboratory fees because there is less material costs and manufacturing time. There is also less chair time for the dentist. It takes a fraction of the time to deliver an all-in-one IPS e.max abutment crown then the traditional crown that is cemented to an abutment.

The combination of a strong esthetic material with the ability of a screw retained option has allowed us to produce an amazing alternative to the older PFM implant restorations.

Fig.1) vertical fracture resulting in a hopeless #5  Fig.2)  Extracted #5  Fig.3)  NeoLink™ placed into soft tissue model

Fig.4)  Waxing sleeve placed onto NeoLink™  Fig.5)  Wax-up of #5 implant crown  Fig.6)  E.max single pressed coping

Fig.7)  Glaze firing applied  Fig.8)  E.max coping cemented onto NeoLink™ with resin after fit confirmed intraorally  Fig.9)  All-In-One Abutment crown removed to clean cement

Fig.10)  Margins polished and checked  Fig.11)  Healing abutment removed  Fig.12)  Restoration placed with Neoss screw and torqued to 32 Ncm

Fig.13)  Final occlusion verified  Fig.14)  Access hole filled with teflon tape and matching composite  Fig.15)  One week post-op

Dr. Mahnaz Syed

Dr. Soheila Etemadi

Fig. 1

Fig. 2-4

Fig. 5

Using an early implant placement protocol of 6-8 weeks post tooth loss Dr. Syed placed two Neoss implants with 40 Ncm insertion torque (Fig. 5). Bone was present on the buccal surfaces of the implants with a slight dehiscence in the 22 region. Bone grafting using Bio-Oss xenogenic bone and Bio guide resorbable membrane were used. Due to the degree of bone
augmentation and soft tissue augmentation planned, a two stage approach was chosen and cover screws were placed at the time of implant placement with tension free primary closure of the soft tissues.

The implants were reviewed on a 1 week one month 3 month basis and during this time Dr Etemadi mapped out her plan for addressing the patients aesthetic concerns. A soft tissue graft was planned to further augment the buccal tissues and provide labial tissue bulk (Fig. 6-8).

6) At surgery  7) One week post surgery  8) Three weeks post surgery

After surgical site healing, a prosthodontic review was organized to evaluate the missing teeth space, gingival level, lip support and patient expectations. The patient's concerns were: 1) Missing 21, 22  2) Length of 11. Dr Etemadi then proceeded with the planned changes to the aesthetics and the temporary crowns to architect the soft tissue with Dr Syed's guidance.

Fig. 9

Three options were presented to the patient: 1) Shortening 11, and leave it as it is 2) Shortening 11 and fabrication of a porcelain veneer to improve the shape of 11, 3) Shortening 11, fabrication of porcelain veneers on 11 and 21, and implant crowns on 21 and 22 to achieve best aesthetic and symmetrical result. The patient choose the third option. The veneers and crowns were inserted after patient's approval and assuring fulfillment the treatment goals (Fig. 9).