Cement sepsis is now thought to be a leading cause of peri implantitis. It will lead to bone loss around an implant and ultimately to total implant failure. This iatrogenic problem is easily preventable. Avoiding intraoral cementation is the key. This is simply accomplished by fabricating screw-retained implant crowns wherever possible.

Fabricating cement-retained implant crowns with CEREC is simple and predictable. Fabricating screw-retained implant crowns is also very easy and makes the placement visit fast and enjoyable. This is a procedure I tend to do in two visits, which makes this totally stress-free. It's a total win/win for both the doctor and the patient.

Simply, I take a fixture-level impression and images of the opposing arch and buccal bite, pour up a soft tissue, place the appropriate abutment and adjust it as needed. I image the abutment and design the crown as usual. I make the restoration transparent, and using the Form Minus tool, I make a hole directly over the screw hole in the abutment. I mill the crown, finish the screw hole by hand and complete the crown. Then I cement the crown to the abutment and thoroughly clean up the extruded cement.

At the place visit, I just unscrew the healing cap and screw in the restoration and abutment as one unit. Now, surely there are more nuances to this technique than I have listed. After a few, you will find so many shortcuts to make your life easier. Challenge yourself to do this and you will be totally convinced that this is a fantastic way to do dentistry. Most importantly, you will remove the risk of the dreaded cement sepsis.

There are multiple threads on the cerecdoctors.com discussion boards to help you through the learning process, as well as videos to visually walk you through. CEREC and implants are a match made in heaven. We have the accuracy and the materials to make fantastic restorations. Do it and make dentistry fun.

One more thing to mention: Using the InLab software and fabricating a custom abutment will also help to avoid cement sepsis. The custom abutment will raise the cement margin to be at or just slightly below the gingival level. The crown is then cemented, and the extruded cement is easily cleaned up. Both ways work well. Do what you feel comfortable with.

I love the idea of this technique, but have some questions: Are you refining the access hole before firing e-max? Do we have to worry about microfracture? And, since the design is done without the gingiva in place, are you replacing it to finalize contours? Exciting concepts. Blue-cam and 4.* softwear completely changed my use of CEREC. Mine was gathering dust. Also, the help here has been invaluable. Thanks, George Olfson

Hi, Yes I am refining the access hole in the blue state. I place the restoration on the abutment to get it perfect. With a high speed diamond and water spray and a light touch I do not worry about microfracture. Go easy though. After milling I also check the fit with the gingiva in place. That helps to guide my decision. If I love the emergence I will laser the tissue in the mouth to fit the restoration. There is a limit to this however. I also will adjust the restoration's emergence at this point if necessary. I am glad you are reinvigorated with 4.0. Jeff

Can the Tibase be used as a stock abutment?