Often a patient may desire a fixed restoration due to greater stability than a removable partial denture. In the past, if there were no abutment teeth present, very few viable options existed. But today, with the advent of dental implants, many patients can now receive the type of dental treatment they desire. This case report highlights the use of the Spline Engaging Shouldered Abutment (ESA). This prosthetic option offers the strength, accuracy, and precision of indexing the abutment to the spline on the superior aspect of the implant for which the Spline dental implant interface is renowned. This abutment affords a clinician the option of also engaging the abutment for single tooth, screw-retained applications or bypassing the engagement at the abutment/prosthesis level to splint multiple units.

Case Report
An active woman in her mid-40's presented in my office with a long-span edentulous space in the lower right posterior quadrant. After an intra-oral exam, treatment options were discussed. The patient rejected conventional treatment with a removable partial denture. The patient was informed about the possibility of dental implants and a treatment plan was formulated.

While the preferred treatment for posterior edentulousness in this office is one implant for each missing tooth, in this case it appeared that only three implants would be possible. To optimize the biomechanics for a four-unit bridge, it was decided to place the implants in the second premolar, first molar, and second molar areas with a cantilevered first premolar. The implants chosen were 3.75mm diameter Spline titanium plasma spray (TPS)-coated screws.

After the appropriate healing period, the implants were exposed with a mid-crestal incision using care to bisect the remaining keratinized tissues. Spline temporary gingival healing cuffs were placed after using the bone contouring tools to remove any bony spicules or fragments. The soft tissues were then allowed to heal around the temporary gingival cuffs.

The "step by step" will walk you through the entire procedure.