Darin O'Bryan With the addition of custom abutments in the chair side software there are a lot of questions that arise. One of the more common questions is how to fill in the access hole. There are three materials that work well for this; gutta percha, pvs impression material and Teflon tape. Teflon tape is the least costly so this is what I use. For a hybrid abutment this is all that is needed.
Now when you are doing a hybrid crown it changes. The access is exposed to the oral cavity and needs to be sealed. When preparing the crown for mounting on the TiBase I also prepare it for the final fill. First I bevel the occlusal margin to remove the glaze around the access. Then the internal is etched not only where you will engage the TiBase but also at the top where the filling will go including the beveled area. Then all the surfaces that have been etched are coated with Monobond.
All the pieces are then bonded with Multilink Hybrid Abutment Cement and allowed to set. The restoration is then placed and torqued to the proper setting. Then Teflon tape, gutta percha or pvs material is placed is placed to cover the screw. If the area of the access opening gets contaminated with saliva or blood, apply some Ivoclean to the area to get rid of any salivary proteins or blood.
Once this is done, apply more Monobond and allow it to sit and air dry. Then fill with your favorite composite and cure. This method will create a good seal, prevent staining around the margin and make for a long lasting restoration.
