Saving a Screw-retained Crown: What would you have done?

[drdangober]

Due to the ridge contour following GBR, implant # 8 was placed in a position that resulted in the crown having the access hole just behind the incisal edge (left of photo). The composite closing up the access hole was in occlusion with the patient’s mandibular teeth and she complained that it felt “deficient” to her tongue and was uncomfortable. She requested a cement-retained crown instead.

Before abandoning the screw-retained, a new crown was fabricated using an “Angulated Screw Channel” so that the access hole was in the palatal fossa (right of photo). Fortunately, the patient found this crown much more comfortable and was happy with the outcome. If this had been your patient, what options would you have offered the patient and what would be your preference?

[admiral518]

Another alternative is to place teflon tape over screw, add base of flowable composite, scan and mill an occlusal inlay. I would bond it in place and polish. Should be indistinguishable to the tongue. This is an easy restoration, 1 visit with a Cerec mill. The access hole should be minimally sized using the “fat” flat ended diamond used for inlays for milling purposes.
As an aside, there used to be a company that had preformed ceramic inlays. The name escapes me.