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.
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 not always necessary. 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!
In today’s day and age of 3-D crown fabrication often times a custom abutment and/or screw retained crown can be a nice upgrade.
A well-placed implant allows me to use a pre-fabricated or semi-custom 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.
- Implant that is very deep
Here is a picture of a custom white zirconia cementable 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. Sometimes a screw retained custom crown is a better option then a cementable.
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.