There is a lot of confusion with patients that have come to me for 2nd opinions. The question is whether or not their dental implants need custom abutments or not.
I will try to make this as non-technical as possible. If you are confused, comment below and I will reply.
Most implants have three pieces. The implant that goes in your bone, the abutment the holds the tooth, and the crown tooth that attaches to the abutment.
In my practice the additional expense of a custom abutment is only necessary about 10% of the time. It can increase the cost of the dental implant by about 10%.
The best way to avoid making a custom abutment is for your implant to be placed correctly. Many implants are placed incorrectly at a incorrect angle and require a custom abutment to make it straight again.
Nothing beats a well-placed implant!
A well-placed implant allows me to use a pre-fabricated abutment and reduce cost to the patient. This type of abutment also has a better fit than a custom one since the titanium mating surfaces was manufactured to fit very tightly. Well made dental implants have a very tight connection between the implant and the abutment. This is very important for the long-term maintenance of your bone around the implant.
Here is case of the back molars replaced with dental implants and prefabricated abutments:
I use custom abutments for the following scenarios:
- An implant for an upper front tooth where the gum may be thin and the titanium would show through. (White zirconia abutment)
- The space between your upper and lower teeth is really small and the implant need to be held by a screw instead of by cement.
- Multiple or full mouth bridged dental implants.
- Overdentures that have a bar to hold them in.
- Excessively thick or thin gums.
- Excessively "scalloped" gums.
Here is a picture of a custom white zirconia abutment and the final crown that I made:
Sometimes the way the gum heals from the surgery may change an original plan for a prefabricated abutment to a custom one.
I teach classes to other dentists about dental implants. Most dentists are not aware when you should use a custom or prefabricated abutment.
As a Diplomate of the American Board of Oral Implantology (the highest certification acheivable), dentists and patients seek me out for education and opinions on what is the best treatment.
My goals are to simplify and streamline the procedure for patients. I do see an overuse of customized abutments when the prefabricated one would have been just as good or better.
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Beautiful coverage here…the pics are so descriptive…thanks a ton for this nice update it can almost be a study material.
Dr. Amin,
I have a situation that I would appreciate in getting your professional opinion on.
Tooth number #19 I had an Implant that was placed incorrectly at an angel. Very uncomfortable because there is a big gap by the gum line between 19 & 20, food gets trapped all the time and there is a major gum recession on #20 which has become extremely sensitive to cold & Air . After I expressed my concern to the performing Perio, he suggested custom made Abutment in supporting the new crown that would fill the gap between 19 & 20…
In your professional opinion, would you say it would be better for me to go with custom abutment and new crown or have the implant removed and bone graphed again and redo the whole implant in its correct position????
After reading the information about custom abutment and the draw backs I am concerned that this may be a temporary fix rather than a permanent one. Btw, he also suggested in having gum Graf on facial of #20 to reduce the sensitivity..
Look forward hearing from you.
Morgan
Hi Morgan,
The angle of placement of a dental implant is very important.
Unfortunately, without examining you, I can not tell you if it is a good plan.
Anyway to post some pictures or x-rays for me to look at?
Sorry,
Dr. Amin
Dr. Amin,
I greatly appreciate your response to my email. Per your request I have a clear photo of the x-ray for your review but i would like to know how to send it to you.
Look forward hearing from you.
Regards,
Morgan
DR. AMIN,
I HAD AN IMPLANT PUT IN ABOUT 6 MONTHS AGO AND I AM GETTING READY TO HAVE THE ABUTMENT AND CROWN PUT IN. MY DENTIST IS CHARGING ME 1250 FOR THE ABUTMENT ALONE. I ASKED WHY MY PERIO CHARGED ME 477 FOR THE SAME PIECE 6 MONTHS AGO (WHICH HE SENT TO HER OFFICE). SHE TOLD ME IT WAS BECAUSE SHE USES BETTER MATERIAL AND THERE WAS A PIECE THAT WENT IN BETWEEN THE ABUTMENT AND THE CROWN. THIS IS ALL NEW TO ME AND I AM JUST WONDERING IF SHE IS OVER CHARGING OR IF THIS IS CORRECT. MY PERIO SAID HE WOULD CREDIT ME THE 477. I AM JUST TRYING TO FIGURE OUT WHAT THE DIFFERENCE IS BETWEEN HIS (477) AND HER (1250) ABUTMENT. ANY INFO WOULD BE HELPFUL. THANKS, MIKE
Hi Mike,
What is the charge for the crown if the abutment is $1250?
This will help me answer your question!
Dr. Amin,
I too am about to have abutments and crowns fitted on teeth #10 and #11 when I can find a dentist to do this.
Firstly – does a periodontist need to fit the abutments I currently have healing abutments and a flipper) and crowns or can any dentist do this?
Secondly – can you give me a rough price scale for a custom zirconium abutment? (I am assuming that i would need custom as these are 2 front teeth).
Many, many thanks if you can help me with this, Emma (CA)
Hi Emma,
A periodontist does NOT need to do this. Who ever is making the crowns should make the abutments for the best results. The #10 and 11 area is a very tricky area of the mouth when two implants are right next to each other.
See this post: http://www.dentalimplantdentistryblog.com/2009/04/the-triangle-of-gums-between-teeth-and-implants.html
Don’t just find “any” dentist to do this. Look for someone who is a Diplomate of the American Board of Oral Implantology /Implant Dentistry and a
Fellow of the American Academy of Implant Dentistry. You will be in good hands with them.
From the cost perspective they may be around $750.00 each.
Does this help?
My dentist did not give me the price for the crown and abutment until after the implant was placed. He is charging me 4,200k for 3 teeth is this too much?
You own a amazing flair .Best of luck and keep going.And yes i have tweeted your site
Dr. Admin
My mom had a implant on her lower right canine n her doc says she needs an custom abutment Bc her gum line is the same level as her implant . He used a 5mm He recommended her to get a gum reduction but says she must pay 650. I was informed that he probably inserted the implant wrong n he shouldn’t even charge us for it. What can I do if He says she has to pay?
Hi Phoung,
The need for a custom abutment does NOT mean the implant was placed wrong!
Sometimes you have to use them to make a tooth just right.
Dr. Amin,
I just had an immediate implant put in the place of tooth #21. That tooth few years ago had a root canal done and crown put on top and just few months ago it broke at the gum level. So the specialist recommended immediate implant and it was placed at the same time when he extracted the rest of the tooth. It has been 3 weeks from the surgery and I am little nervous because the tooth next to it is still tender ( the tooth that is on the right side of #21 when you facing me) As I looked at the ex-ray it looks like the implant is pretty large and its right up to the tooth that is tender. Should I be worried? Is that normal for the implant to be so close? I do not have very big teeth or bite so I am also some what worried that the healing cap seems to be taking the whole space between the two teeth. When the doctor placed the abutment just to try it out right after the surgery I could not even close my mouth because it felt larger than a tooth. He mentioned something about getting a smaller abutment. Is the immediate implant usually larger than the two stage implant? I know that the general dentist will have to put on a crown in about 3 months. how much room is it necessary around the abutment for the crown to fit? Please let me know if you have any recommendation or should I just let the professionals worry about what they have to do.
Sincerely
MH
M.
Hi MH,
The x-ray you are looking at is a two-dimensional image of a 3D object. Sometimes implants on x-rays can look like they are on top of one another or touching things that they really arent.
Please make sure your dentist, knows about the tender tooth.
Some immediate implants are bigger or smaller than the original tooth.
Please keep me posted with your progress.
Dr. Amin
I just finished the process of having the surgical portion of the implant done (which involved a bit of bone grafting, so it’s taken 7 or 8 months to get to this point). I phoned my dentist to schedule having the tooth portion (sorry don’t know terminolgy) made. I found out that just this portion is going to cost $3000. The dentist’s office told me that it is “$1500 per abutment.” I only have one tooth missing, and only one implant, but apparently my dentist “always” uses two abutments. Does this make sense to you? Is this normal? I’m suffering from sticker shock. (This is, of course, completely separate costs from the surgical part.) Is there a cheaper acceptable option? It will take me at least a few months to save this much. Is there a time limit?
Hi Linn,
The “two” abutment part sounds odd if it is only one implant. It may be a “two-piece” implant or abutment.
Keep in mind the the crown and abutment usually cost MORE than the surgery.
Respectfully,
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com
I have been told my wife needs a molar replaced with an implant. We dont have alot of money to pay for this. Groupon has a deal going on that reads as follows…$999 for Titanium Dental Implant and Prefabricated Abutment (Up to $2,100 Value) this is from a company called Dental Masters. 24hr cancellation notice required. Services are non-transferable. Not valid for bone grafting, bone augmentation, or any further diagnostic aids or treatments. Consultation required.
Does this offer seem valuable?
Hi Pete,
This ads are like teaser rates on credit cards. Based on the ad, there is no “tooth” crown on the implant so it is misleading.
Many of these facilities are “mills” where patients are just churned out. Remember you are replacing a body part…time, skill and planning need to happen in order to have a lasting, great result. I have personally had to redo many implants done in these “super-center” type of offices. You will probably see many different dentists.
I would not do it.
Ramsey A. Amin, D.D.S., D.A.B.O.I.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Fellow – International Congress of Oral Implantologists
UCLA and Western U. Dental School Faculty
I am going to put zirconium crown on tooth #12. My dentist want to use titanium abutment with zirconium crown. But I think, that abutment should be zirconium too.
He told me that zirconium is fragile.
Hi Galina,
If your gum is thick, the zirconia will block the metal from showing through. Yes, having a titanium abutment is stronger but zirconia abutments are not fragile at all.
Ramsey A. Amin, D.D.S., D.A.B.O.I.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
UCLA and Western U. Dental School Faculty