Dental Implant abutments /certified fixed orthodontic courses by Indian dental academy

IMPLANT ABUTMENTS

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INDIAN DENTAL ACADEMY
Leader in continuing dental education


ABUTMENT
Portion of implant that supports and
retains a prosthesis or implant super
structure
TYPES
 Depending upon retention
• Abutment for screw retention
• Abutment for cement retention
• Abutment for attachment
 Depending upon angulation
• Straight abutment
• Angled abutment


 Depending upon design
• Flat topped abutment
• Tapered shouldered abutment
• Direct gold copings
• Commercially available
– Steri oss abutment
– Paragon abutment
– Ceraone abutment
– Ceradapt abutment
– UCLA abutment
– Noble bio care abutment
– Estheticone abutment
– Mirus cone abutment
– Noble pharma single tooth abutment
– Branemark system angulated abutment
– Astra abutment

Cement retained abutments
• Better passivity
• Easier to obtain esthetics
• Fewer porcelain fractures – due to occlusal surface
integrity
• Less fatigue
• Manipulation in posterior region is easier with cement
• Loosen less often compared to that of screws
• Occlusal surfaces remain intact as there are no screw holes
– better axial loading


Disadvantages
• Difficult to retrieve unless soft cements are used
• Abutments sometimes must be prepared
intraorally
• Gingival retraction may be needed
• When permanent cements are used evaluation and
maintainence of implants is difficult
• Increase in the momentum of force


Types of abutment for cement
retention
1.Single unit or one piece abutment
2 .Two piece abutment
1.Single unit or one piece abutment
- does not engage anti rotational hex
but fits flush with the implant
platform
2 . Two piece abutment
- has one component to engage anti
rotational hex of implant body and
other component to fixate the
abutment and implant body together

Screw retained abutments
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Low profile of retention
Less momentum of force
No risk of cement in the sulcus
Easily retrievable

Disadvantages
• Loosening of the screws
• Difficult to obtain passivity
• Difficult to obtain esthetics
• Greater chances of porcelain fracture
• Access in posterior regions difficult – risk of aspiration


Factors that affect screw connection
1. misfit
2. poor abutment screw tightening
3. excessive occlusal loading
4. settling of screws or abutment
5. inadequate screw design
Misfit has been reported to be as high as 66
micrometer between implant and abutment in
vertical direction , 10 degrees in rotational
dimension and 99 micrometer in horizontal
dimension
Guidelines usually recommend the screw to be
tightened by 50 – 70 % of yield strength


Abutment for attachment
• Uses an attachment device to retain a removable prosthesis
• Includes
Mesostructure bars – continuous and non continuous
Super structure attachments – magnets , custom clips , hader clips
of plastic or gold , dolder clips , ceka attachments , zest , zag anchors
, octalinks , o rings , ERA attachments , pin locks and lew
attachments


STRAIGHT ABUTMENT
-Indicated for replacing
single tooth for large prosthesis
upto full arch, implant borne
reconstructions
- used only when emergence
profile are parallel
- if abutments are not parallel
– can be prepared by
• Direct method
• Indirect method


ANGLED ABUTMENT
-available in angulations from 10-30
degrees
-improved esthetics
-To correct path of insertion
-Increase in angle – increase risk of
fracture
-placed as deeply as possible with
most favourable axis orientation


• ABUTMENT DESIGNS
FLAT TOPPED ABUTMENT
-used to support bars for
overdentures/ fixed detachable hybrid
prosthesis
-Donot engage antirotational
component
-advantage – simplicity
- disadvantage - does not have
counter rotational forces- unsuitable for
single tooth replacement
-straight emergence profileunesthetic in anterior maxilla


TAPERED SHOULDERED ABUTMENT
-indicated in – bars to overdentures, hybrid overdentures,
single tooth replacement
-tapered design-resistance to lateral forces
-lower profile abutment collars- subgingival margin –
esthetic
-tapered shoulder- angled at 9-15 degree


DIRECT GOLD COPING
-coping bypass abutment entirely
-consists of two parts- coping and screw
-porcelain is baked directly on to coping – results in
crown which attaches directly to implant body
-coping engages antirotational component of
implant
Indications
o Single tooth restorations that don’t require alteration of
angulation
o Limited interocclusal space
o Minimal soft tissue thickness
o Where subgingival margins are required


Antirotational features of abutments
External hex
o Most widely available
o Found on top of abutments
o Hexagonal geometry

Internal hex
o Provides more precise implant
abutment interface
o Disadvantage – screw loosening
o Seats the abutment into hexagonal
depression


SPLINE ATTACHMENT
Splines are fin to groove anti rotational design
Consist of six external components called tines which
protrude 1mm from implant and are matched to a female
embedded in a abutment base


MORSE TAPER ATTACHMENT
-Consist of 1 piece abutment post with 5 degree taper
-resist rotation and even removal
-also referred to as cold welded design


Guidelines for abutment selection
• Depth of soft tissue

vertical height from implant
head to the gingival margin
 Measured with periodontal
measuring probe
 labial margin of abutment is
atleast 1mm subgingival
 Marked discrepancy between
gingival heights around the
margin – prepable abutment is
indicated
 Diameter close to that of
cervical margin of tooth


• Emergence profile
 Need atleast 3mm of vertical space from implant head to
gingival margin
 Allows gradual transition from implant head


• Orientation
 Ideally implant is placed close to the long axis of missing
tooth (thro incisal tip or just palatally)
 Small degree of labial angulation – easily accomodated
with standared abutments
 If more labial angulation needed – use of standard
abutment leads to
1. Excessively contoured labial surface
2. Porcelain surface too thin to mask metal structure
 Better results achieved with prepable / fully customised
abutment


• Interocclusal space
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Space from implant head to opposing tooth
Vertical space of 6-7 mm – standard abutment
5mm of space – prepable abutment
Less than 5mm of space – vertical dimension of occlusion
increased, deeper implant placement

• Special esthetic requirements
 Angulated abutments – for esthetics and biomechanical
reasons


ABUTMENT RETENTION
The retention of a fixed cemented
restoration – resist removal of the retainer
along the path of insertion
Resistance – opposes movement of the
abutment under occlusal loads and prevents
removal of restoration by forces in apical
and oblique direction


The tenets of retention and resistance include
• Abutment taper
– Retention of a crown decreases as the taper is
increased from 6-25 degrees
– Ideal taper was recommended to be within 2-5
degrees of parallelism of path of insertion
– Parallelism of axial walls has been recognized to
be single most factor for retention
– Eames et al – found that clinically acceptable
preparations present a taper of 20 degrees


Abutment surface area
 There is linear increase in retention as the
diameter increase for preparation with identical
height
 Diameter of an implant abutment for cement
retention is often less than 5mm which is
comparable to prepared lateral incisor – so
decrease in surface area results in poorer
retention than most natural abutment


Abutment height
 A tall preparation offers greater
retention than a short abutment
 Increase in height – increases
surface area , increased
resistance to lateral forces
 Height of the abutment must be
greater than the arc formed by
the crown rotating about a
fulcrum at the margin of the
opposite side of the restoration


 Abutment surface roughness

 Surface roughness increases the retention of a restoration by
creating micro retentive irregularities into which the luting agent
projects
 Surface roughness retention is dependent upon the type of burs
along with the type and thickness of luting agents
 Large size cross cut fissure bur – reduce height and gross
reduction of metal abutment post
 Coarse diamond – increase amount and depth of microscopic
scratches on the surface to more than 40 micro meter
 Internal aspect of the casting should be air abraded with 50 micro
meter alumina to enhance retention by 64%


STERI OSS ABUTMENT
Central retaining
screw which fixes abutment
to implant after engaging the
external hex
PARAGON ABUTMENT
- Angled abutment
system
- Presented with three
components - the collar with
hexagonal base , external hex
-octagonal.
- offers 3 angled abutment
position ( 15,20,25 degrees ) .
so entire system offer 24
possible combination of angle
and direction

CERAONE ABUTMENT
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Components :
Implant coping
Abutment replica and healing cap
Gold abutment screw
Abutment
Titanium fixture
Cut down coping
Aluminium oxide ceramic core
Abutment available in 5 heights –
1,2,3,4,5 mm


- Designed for anterior maxillary
single tooth cementable porcelain
restorations
- Consists of implants with non
rotating interface with abutment
and gold alloy abutment screw
- Ceramic cap –available in
cylindrical form for posterior arch
and tapered form for anterior arch
that fits over ceraone abutment
- Cap- made up of densely sintered
semi translucent aluminium oxide
which is designed to be fused with
porcelain and cemented
permanently to abutment

- In posterior areas- ceraone
abutment is used with
ceramometal coping
- Since esthetics may not be critical
in posterior areas, plastic wax up
coping is used to fabricate
ceramometal coping with or
without access channel to which
porcelain is fused
• To facilitate during
troubleshooting , a lingual
removal button is designed
• A narrow occlusal access channel
can also be fabricated in gold to
facilitate reentry


• ESTHETICONE
ABUTMENT
- Noble biocare abutment
- hex shaped,tapered sides
- features a female hex which
interface with implant male
hex head and is secured by a
titanium abutment screw


- indicated in multiple implant
situation without causing
esthetic compromise with the
metal display
- designed to allow esthetic
veneering material to be
placed subgingivally
- abutment made of surgical
grade titanium and available
in 1,2,3 mm collars


• CERADAPT
ABUTMENT
- All ceramic alternative to metal
abutments
- Pre machined precision milled
abutment made to fit the implant
hex
- made up of densely sintered
99.8% pure aluminium oxide
which are pressed into desired
shape and subjected to sintering
temperature of 2050 degrees
Celsius
- pore free strong wear resistant
stable bio ceramic material

- Andersson and Oden showed
flexural strength of 690 MPA and
demonstrated that the abutment can
withstand tremendous loads without
fracturing
- it is a non metallic , non corrosive ,
bio compatible.soft tissue response
is excellent
- tooth coloured and light diffusion
property – more natural and esthetic
implant crown
- used for implant supported single
and multiple tooth restoration in the
anterior canine and premolar regions
- can be either screw or cement
retained


• OCTA ABUTMENT
- Low profile component used with ITI implants
- Used in esthetically sensitive maxillary anterior region
- Pre fabricated gold caps are available for attachment to
removable super structures
- Internal octagonal design – resistance against crown
rotations


• UCLA ABUTMENT
- Improved esthetics
- Gold alloy abutment screw
retention increases the
preloading force
- Abutment can be custom
reangulated
- All abutment have a non rotating
configuration
- Improved emergence profile


- Each restoration has a tapered interface similar to that of a
standard FPD restoration
- Multiple butt joint prosthesis interface avoided
- Lingual screw retention for fixed retrievability - practical
and esthetic


• CUSTOM REANGULATED UCLA
ABUTMENT
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Eliminates need for prefabricated angled abutment
Simplifies construction
Results in better esthetics
When implants are not parallel , parallelism can be
obtained
- Abutment fabricated to interface directly with the implant
using a pre machined gold palladium cylinder


- Secured with titanium abutment screw
- Pre machined internal hex interfaces with implant male
hex provides maximum resistance to lateral forces and
screw loosening
- Lingual surface of abutment is tapped to receive a gold
screw – fixed retrievabiltiy


• NOBLE PHARMA SINGLE TOOTH
ABUTMENT
- Titanium abutment cylinder connects to the implant
fixtures
- Available in various sizes depending upon the thickness of
peri implant tissues ( 1-5 mm )
- Restorations are designed to be cemented
- Two piece elements (crown and abutment cylinder) is
connected to implant fixture with a titanium screw


• MIRUS CONE ABUTMENT
- Used for multiple implant screw retained restorations
- Available with 1,2,3 mm collars
- Soft tissue thickness determines appropriate collar height
- Designed for situations where inter occlusal distance is
minimal
- gold alloy screws with hex head retains abutment with
implant


• BRANEMARK SYSTEM ANGULATED
ABUTMENT
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Developed by Noble pharma
Designed to adjust access hole position,prosthetic
screw angulation
Improved esthetics
30 degrees, 12 sided internally designed component
which can be in 12 different positions
components:
Implant
Angulated abutment
Abutment screw
Gold cylinder
Prosthetic screw
Brass replica
Healing abutment


ASTRA ABUTMENT
• Presented with the option of 20 or 40 degree tapered top
• Used for fixed bridges / over dentures


Abutment try-in kit
• Provide replicas of abutment types that can greatly assist
abutment selection
• Tried intraorally or on a cast
• Made up of aluminium – not damage the implant
• Color coded for easy recognition
• Used for better screw access position ,marginal height and
emergence


• TREATMENT PLAN
• Single tooth implant abutment
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Two piece abutment with straight emergence profile
Two piece abutment wider than implant body
Two piece anatomic or bioesthetic abutment
Two piece custom abutment


• Fixed / fixed detachable prosthesis
 UCLA Abutments
 Similar custom cast abutments
• Hybrid bridge fixed detachable prosthesis
• Fixed bridge made of denture teeth processed to cast
metal barlike frame work.
• Prosthesis must be screw retained and is usually used in
arches that are completely edentulous
• standard , conical ,Tapered shouldered ,flat topped
abutments
• The abutment acts as platform on which the hybrid bridge
framework seats


• Implant supported over dentures
•
Shouldered abutment that accepts a screw
retained bar / super structure attachments
•
O ring , zest attachments , paragon
attachments


JOURNAL REVIEW


Removal of a fractured implant abutment
screw ( Ibrahim , JPD,June 2004)
Implant repair kit :
• Center bit
• 1.3mm twist drill
• 1.9 mm twist drill
• Conical instrument to retrieve the fragment
• Manual tapping instrument


A locating splint for placing implant abutment
(Edmond , JPD , Jan 2004)
• After placement of abutment , a definite impression is
required because slight rotation of abutment is observed
• This article presents a technique to avoid this.


Computer generated Procera abutment
• Custom abutment-designed by a computer and machined
to exact specification
• Head of implant impression made and working model is
placed in the scanner
• Readings of implant angulation and position are taken
• Using cad-cam software,ideal abutment is generated
• Advantages
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Precise fit
Ideal emergence profile
Improved esthetics
Proper restoration contours

Bibliography
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Atlas of oral implantology – A.Norman Cranin
Contemporary implant dentistry – Carl.E.misch
Implants in clinical dentistry – Richard.M.Palmer
Implant prosthodontics – Stevens Friedrickson
The Branemark implant system – John Beumer
Dental implants fundamental and advanced lab
technology – Winkelman
• Atlas of tooth and implant supported
prosthodontics – Lawrence.A.Weinberg

Leader in continuing dental education


Dental Implant abutments /certified fixed orthodontic courses by Indian dental academy

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