Placement of restoration, posterior zone
- Timing of placement.
- Cement or screw retained.
- Provisional vs. permanent placement.
The final step of any restorative procedure is the placement of the permanent restoration. The sequence of steps to be followed is fairly universal. Depending on the the design of the final restoration (cement or screw retained) the steps may vary depending on the practitioner, what is currently in place (healing abutment, custom abutment, stock abutment etc).
The most straight forward would be when the provisional is in place, and all soft tissue is healthy. In the case of the cement retained crown the provisional is removed, the crown is seated adjusting the interproximal contacts and checking occlusion. All excursive movements are checked. Depending on the clinicians choice a provisional or permanent luting agent can be used. Following the cementation procedure the area is thoroughly cleaned and all residual cement is removed. Occlusion should be checked one final time. If the practitioner decides to use a provisional cement, this should be discussed with the patient and future visits should be scheduled to check for cement wash out.
In the instance that the crown is to be screw retained the provisional is removed, the final restoration placed, checking contacts points. The occlusion is verified in all aspects. The abutment screw (if the restoration is to fixture level) should be torqued to manufacturer specifications. The access opening can be filled with a variety of provisional seals if desired (pellet, Teflon tape, Fermit etc) or be sealed with a permanent restorative material (composite). Care should be taken to make sure there is a intermediate barrier between the permanent material and the screw. This will insure that the screw will not be damaged by a rotary instrument if there is a need to retrieve the restoration.
The variation to the above is if there is a healing abutment in place at the time of the placement of the final restoration. This is sometimes problematic as it does not allow for the development of proper soft tissue profiles. It would be recommended to place the abutment / crown and allow a period of time for soft tissue adaptation and maturation. After an adequate time period one of the above pathways should be followed to complete the restorative phase.