EPA 4C: Partial Edentulous Fixed Partial Denture - Implant Supported

Isolation and Soft Tissue Management

• No iatrogenic damage to soft peri-implant soft tissue
• Throat pack used during placement and removal of implant components/ restoration

• Minimal tissue damage consistent with placement and removal of implant coping

• Soft tissue damage inconsistent with procedure
• Missing throat pack

• Gross iatrogenic damage to peri-implant soft tissue due to repeated placement and removal of coping
• Significant soft tissue damage requiring specialized care (e.g. sutures)

IMPRESSION

Impression coping placement

• Impression coping seated completely and verified with a radiograph

• Impression coping seated completely but screw

• Missing verification radiograph

• Impression coping incompletely seated
• Coping screw torqued with a torque wrench or fractured coping
• Failure to place healing abutment back on

Impression

• Peri implant soft tissue cuff accurately captured.
• Coping is stable within the completed impression
• All teeth accurately captured without voids/distortion/ burn through
• Appropriate impression coping, impression materials and tray selection
• Adequate opposing arch record and accurate inter-occlusal record

• Minor void present along peri implant tissue that will not affect implant crown fit
• Final impression/ opposing arch impression shows minor voids/ distortion/ burn through in non-critical areas

• Final impression/ opposing arch impression shows major voids/ distortion/ burn through in non-critical areas

• Voids/ distortion in critical areas of peri implant tissue or remaining teeth (proximal surface of adjacent teeth or occlusal surfaces).
• Coping unstable within completed impression
• Inappropriate impression coping, impression materials or tray selection
• Inadequate/ missing opposing arch impression/ interocclusal record that precludes implant crown fabrication

RESTORATION (PROVISIONAL/ DEFINITIVE)

Abutment and or Crown fit and stability

• Complete seating with stable, passive fit. Verified with a radiograph

• Stable with light premature soft tissue or proximal interferences till complete seating

• Stable with significant premature interferences till complete seating: needs recontouring

• Incomplete seating with severe rocking/ rotation. Learner recognized the need to re-impress. Missing verification radiograph.

Occlusal Anatomy and Contacts

• Anatomy conforms to existing tooth form
• Multiple centric contacts present with ideal intensity and location. Restored with mutually protected occlusal scheme

• Anatomy lacks definition
• Light/ heavy or insufficient centric contacts present

• Significant deviation in anatomy in some areas
• Premature occlusal contacts in centric or interferences in balancing or non-functional movements

• Anatomy absent
• Gross hyper occlusion or infra-occlusion

Surface Contour, Proximal Contacts and Finish (inclusive of screw access restoration)

• Ideal anatomic contours, marginal integrity and embrasures
• Convex proximal contacts that are visibly closed, appropriately located with the right intensity
• Highly polished surface

• Slightly over/ under contoured surface
• Proximal contacts are visibly closed but lack intensity or show slight variation in location
• Crown surface slightly rough in finish

• Decidedly over/ under-contoured surface or presence of soft tissue impingement
• Concave, irregular or tight proximal contacts
• Crown surface decidedly rough or pitted

• Grossly over or under-contoured
• Proximal contact visually open
• Crown surface deeply pitted or grooved

Screw access restoration

• Abutment screw torqued as directed by manufacturer. Seating verified with radiograph
• Access sealed with teflon and restorative material under adequate isolation

• Slight variation in access restoration thickness

• Inadequate/ excess access restoration thickness
• Absence of post cementation radiograph

• Incorrect manufacturer’s torque wrench used or over/ under torque of screw
• Missing teflon tape/ inadequate isolation maintained

Cementation

• Appropriate cementation protocol used under adequate isolation
• Absence of residual cement, verified with radiograph

• Minor debris of residual cement
• Absence of post cementation radiograph

• Inappropriate cementation protocol used or inadequate isolation maintained
• Gross presence of residual cement
• Incorrect manufacturer’s kit used or over/ under torque of screw