Seems simple enough right? how to do you restore an implant after it is placed. However, the more implants involved, the options can seem overwhelming at times. When/if should we consider a custom abutment? cement? angulated screw channel (ASC) solution? Let us go over some of the common scenarios you may encounter:
Single Tooth Dental Implant Crown:
Typically a single tooth dental implant crown can be typically restored either using a screw retained option (ASC if needed) or cement retained option. My preference is for the use of a custom abutment in these cases as it can create a natural emergence profile between the implant and crown.
Benefits of a custom abutment
Crown margin depth can be customized
Allows for better hygiene
Allows for better esthetics
Allows for better alignment with angled implants
Zirconia and Gold Hue abutments enhance esthetics of the final case
2-3 Unit Implant Restorations:
As the number of consecutive dental implant restorations increases, so does the complexity of the case as a number of factors come to play: Are my implants parallel ? passivity becomes an issue as the draw (parallelism) may be a factor. Will some of those implants emerge through a facial access hole? So let us look at some options to ensure success of our cases.
Custom abutments for two unit splinted restoration
One custom abutment is pre-bonded
This custom abutment can be either hexed or non hexed, the other abutment will be placed intraorally and splinted restoration to go over top.
Please ensure that you are relieving the area of excess cement by making a duplicate of the crown interior with PVS to pump excess cement extra-orally prior to intra-oral cementation
One option when we start to deal with larger number of consecutive dental implants is to use custom abutments and cement retained restorations. The cement space ensures space for passivity however retrievability can become an issue if you ever need to remove the bridge. So are there better options ?
The use of combination abutments can allow for the best of both worlds: screw retention with the passivity of cement. Shown below is an example of a custom abutment(engaging at back that is prebonded), middle abutment (non engaging and prebonded) and anterior custom abutment (engaging and to be inserted intraorally). This combination of abutments can allow for the back two abutments to essentially slide over the anterior abutment intra-orally.
Multi-Unit Abutments (MUA):
In cases where we have to deal with more than 3 consecutive dental implants, I recommend the use of MUAs. MUAs help to provide passivity for the bridge by acting in a similar fashion to custom abutments but through screw retention mechanisms. The only drawback with MUAS is that they are not customized, so in the esthetic zone, the implants need to be placed deep enough to have adequate tissue thickness to ensure that they do not compromise the aesthetics or space requirements for the prosthesis. Shown is an example of the use of MUAS in the anterior zone on 4 dental implants.
Hope this blog has been helpful to get you going on how to restore your next dental implant case.
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