As implant dentistry requires a lot of decision making, practitioners deserve simplified and dependable options.
When it comes to dental implant restorations, there is always the question of ‘Which type of implant abutment should I use?’
A patient will arrive to the office for their implant restoration with a healing abutment present, screwed onto the implant and ready for the placement of the official abutment. This is when the dentist or oral surgeon must decide between either using a stock or prefabricated abutment vs. a customizable abutment for their patient.
So, which abutment type will be most appropriate for the patient and their unique restoration needs?
Let’s further explore the characteristics of each abutment type so that the process of abutment selection can be made more simple, and implant procedure more predictable:
Stock (prefabricated) abutments
Stock abutments are machine-made and manufactured to standard sizes, and are generally fabricated out of titanium alloys as well as zirconium materials. These abutments can be both straight and angled, and are used for both tissue and bone level implant restorations. Considered as the most economical type of abutment, stock abutment design is aimed to be user-friendly and convenient, and these types are most commonly used for cement retained restorations.
Furthermore, prefabricated abutments are considered to be best for use in tissue level oral implants outside of the esthetic zone, otherwise known as the “smile zone”. This is because with stock abutments, the tissue will conform to the abutment shape, making it challenging for the ceramist to achieve the best emergence contours in addition to achieving optimal tissue support with regard to surrounding teeth. Additionally, with stock abutments, the final margin placement of the implant crown tends to come with a lack of control precision and accuracy, as it is dependent on both the implant’s depth and abutment’s height.
Due to the fact that stock abutments are pre-shaped, they may or may not exhibit the optimal retention and resistance form for a patient’s particular implant site. There is the risk that they will be of inadequate height or lack the anti-rotational element, thus potentially failing to provide full support and strength. They will often necessitate some degree of modification, which can present issues when attempting the creation of the perfect emergence profile.
Preparing stock abutments within the oral cavity is a process that should always be avoided when and if possible. The heat that this process creates, even when adequate water supply is present, in addition to the possible sparking of the titanium metal material, can pose a risk to both the patient’s wellbeing and the success of the dental implant procedure.
To reiterate, prefabricated or stock abutments can and should ideally be prepared outside of the patient’s oral cavity. For an easier preparation, the abutment can either be screwed to an abutment holder or to an implant replica (analog) respective to the type of abutment used.
Customizable abutments require the practitioner to create either a tissue or bone level impression of the dental implant with assistance from transfer impression coping. While this method may be more costly when it comes to the restoration of an implant supported crown, it is considered to be the most efficient approach. Custom abutments come with benefits such as improved aesthetics and the achievement of a natural emergence profile between dental implants and crowns, as well as the ability to create a better alignment with angled implants.
There are a variety of options for customizable implant abutments available to clinicians, including universal abutments based upon cemented coping, as well as titanium abutments or zirconia blank-milled abutments. With that being said, it is a common preference to use a zirconia restoration with a titanium base, involving a metal-to-metal connection to the dental implant. Furthermore, computer-aided design technology is now possible and accessible for the creation of custom abutments.
Another important factor when selecting abutment types
An additional necessary consideration when it comes to choosing the right type of abutment for an implant restoration is deciphering between single unit abutments and splinted unit abutments.
When it comes to single units, abutments that contain an anti-rotational element should be used. This anti-rotational feature will need to depend on the unique design of the implant restoration. It may play a role in engaging the external hex, internal hex or trilobe shape of the implant at the point of connection - therefore the abutment should be engaging the implant’s anti-rotational element as it will not have the ability to freely rotate on the abutment when the screw is not present. All in all, it’s important to closely study the base of the abutment with regards to single unit implants, and understand the type of anti-rotational feature it contains.
Fortunately, restorative options for a single missing tooth have progressed from mere 3-unit conventional FPDs or Maryland bridges in the past, to single-tooth dental implant systems in this present age. And with the over 90% average success rate of dental implants according to multiple studies, it is critical for practitioners today to be as informed as possible when it comes to formularized implant dentistry and processes.
At the end of the day, it is best for dentists, oral surgeons and clinicians to select the type of abutment that will allow them to optimally customize its shape to best support the specific restorative material being used for the dental implant procedure.
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Abutments International is thrilled to a be part of dentists’ success in providing exceptional quality restorations to their patients. Please contact us today if you have any questions, or to inquire about any one of our products.
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