Implant cases: what the lab needs from the practice

An implant crown has more parts than a crown on a tooth. Each part has to match the implant already in the patient’s mouth.

The lab cannot see that implant. It works from what the practice sends, and one missing detail can stop the case.

This guide lists what the lab needs, the decisions that belong to the dentist, and how to keep three parties on the same page.

Why implant cases stall

A crown on a tooth needs a scan, a shade and a material. An implant case adds a chain of components.

What a crown needs, and what an implant case adds

Two columns. A crown on a tooth needs a scan, a shade and a material. An implant crown needs the same three and a chain of components: the implant, placed weeks or months earlier, the part used to record its position, the abutment that joins the crown to the implant, and the screw that holds it.

A crown on a tooth

Three things

• A scan
• A shade
• A material

An implant crown

The same three, and a chain of components

• The implant, placed weeks or months earlier, sometimes by another clinician
• The part used to record its position
• The abutment that joins the crown to the implant
• The screw that holds it

Each comes in many versions. A part made for one implant line will not fit another, and may not fit another size in the same line.

So the lab stops when a detail is missing. It has to, because a guess would cost more than the wait.

Tell the lab exactly which implant it is

This is the detail nothing else can replace.

The details are on the label that comes with the implant, and in the surgical record. Copy them into the chart on the day of placement.

If another clinician placed the implant, ask for the record before the restorative visit. Send a copy to the lab.

Do not ask the lab to identify an implant from a radiograph. It can narrow the options, and narrowing is not knowing.

Record the implant’s position

The lab needs to know where the implant sits, to a fraction of a millimetre. There are two ways to tell it.

With a scanner

A scan body is fixed to the implant and scanned. The software uses its shape to work out where the implant is.

• The scan body matches the implant’s maker, line and platform
• It is fully seated, confirmed with a radiograph where there is any doubt
• Its whole surface is captured, with no gaps
• The gum around the implant is scanned with the healing abutment out
• The opposing arch and the bite are scanned
• The Rx names the scan body used

The last line matters. The lab’s software has to load the same scan body from its library.

Scan the gum soon after the healing abutment comes out. The tissue begins to close in once its support is gone.

With a conventional impression

An impression coping is fixed to the implant and picked up in the impression.

Tell the lab whether the tray was open or closed, and which coping was used. Send any parts the lab needs to pour the model.

Check the lab’s preference before the visit. How to send intraoral scans to a dental lab covers the file side.

The decisions that belong to the dentist

A lab can build an implant crown several ways. Write the choice down, so the lab does not have to ask.

Write the retention line every time. The angle of the implant can rule out one option.

If the lab finds the plan will not work, it should say so before it makes anything. A message at that point saves a remake.

Where a provisional has shaped the gum, say so and scan it. The lab can copy a contour it has seen.

For a bridge on implants, add the pontic design and how the patient will clean beneath it.

Parts and time

Agree who orders the parts. A lab may order the abutment and the screw itself, and include them in the invoice.

Ask whether the parts are in stock. A component on order adds days that nobody at the lab controls.

Implant cases run longer than crowns on teeth. Ask the lab for its implant turnaround, and book the seat against that.

Tell the lab early if the date cannot move, such as a patient who is about to travel.

Give the lab the seat date on the Rx. Dental lab turnaround times shows how to count the days.

What should come back

Check the box when it arrives, well before the patient does.

• The crown, and the abutment if it is separate
• The final screw, unused
• A seating guide, if the abutment needs one
• The model or printed model, if one was made
• A note of the parts used, for the chart

Record the parts in the patient’s chart. Whoever looks after that implant in ten years will need to know.

Follow the implant maker’s instructions for tightening the screw. The lab can tell you which screw it supplied.

Three parties, one record

An implant case can involve a surgeon, a restoring dentist and a lab. Each holds part of the story.

The surgeon knows what was placed. The dentist knows what is planned. The lab knows what can be built.

Trouble starts when that knowledge travels by memory. A phone call covers the detail once, and leaves nothing to check later.

Put it all in one place the lab can open: the implant record, the Rx, the scans, the photos and the dates.

When the lab asks a question, answer on the same record. The next person to open the case can then see what was decided.

Name one person at the practice who follows each implant case from the scan to the seat.

The checklist

• Maker, line, diameter and platform of the implant
• Tooth position in FDI notation
• The surgical record, if another clinician placed it
• Scan or impression with the matching scan body or coping, named on the Rx
• Gum contour, opposing arch and bite
• Screw-retained or cement-retained
• Abutment type, and any preference on parts
• Material, shade and photos
• The seat date

What to include on a dental lab prescription covers the fields every case needs.

For labs: make the details easy to send

A practice that sends two implant cases a year will not remember the list. The lab can carry it for them.

• Publish your implant Rx fields. One page a practice can keep beside the scanner.
• Say which scan bodies you support. It prevents a scan the software cannot read.
• Ask on the day the case arrives. A question on day one costs nothing, and one on day four costs the seat date.
• Confirm the parts and the date. Tell the practice when components are ordered, and when the case will ship.

Incomplete prescriptions covers how a lab can get a complete Rx every time.

On Tusko, the Rx, the scans, the messages and the due date sit on one case that both sides open.

See how it works for labs and for practices.