Understand Types of Implant Abutments and Their Uses

Summary

This video script from 'Implants 101' delves into the complexities of dental abutment selection, a critical aspect of implant restorative dentistry. It outlines the various types, including tissue level and bone level abutments, and discusses cementable and screw-retained options. The script clarifies the roles of stock and custom abutments, emphasizing the importance of choosing the right abutment for optimal implant integration and patient outcomes. It also highlights the value of consulting with implant representatives and laboratories for expert guidance in navigating the myriad of abutment choices.

Takeaways

• 💡 There are hundreds of abutment choices with each implant system, making it one of the most confusing aspects for restorative dentists.
• 🏷️ Abutments can be categorized based on their use in tissue level and bone level implant restorations.
• 🔍 Tissue level implant restorations involve an intimate connection to the implant platform, either with the crown or the abutment fitting directly over it.
• 🔄 Bone level implant restorations connect the restoration to the abutment platform, allowing better bone retention and avoiding micro gaps.
• 🔧 There are four main types of abutments: cementable, screw retained, stock, and custom abutments.
• 🛠️ Cementable abutments involve the restoration being cemented or bonded to the abutment, while screw retained abutments are screwed into the implant.
• 📏 Stock abutments are prefabricated and require adequate restorative space, while custom abutments are milled or cast specifically for a patient.
• 🔩 Bone level implants typically use custom abutments for optimal results, while tissue level implants can use either stock or custom abutments.
• 🦷 Custom abutments can be milled or waxed and cast to fit the exact tissue profile, optimizing emergence profile and tissue management.
• 💬 Consulting with implant representatives and laboratories is crucial in selecting the appropriate abutment for a given case, given the numerous choices available.

Q & A

What is the main topic of the second lesson in 'Implants 101'?

The second lesson in 'Implants 101' is focused on abutments, explaining the different types and their indications in implant dentistry.

Why are abutments considered confusing for restorative dentists?

Abutments are considered confusing due to the hundreds of choices available with each implant system, varying in shapes, sizes, and indications, making it challenging for restorative dentists to choose the right one for implant restorative dentistry.

What is the difference between tissue level and bone level implant restorations?

Tissue level implant restorations have an intimate connection to the implant platform, with the crown or abutment fitting directly over it. Bone level implant restorations, on the other hand, have an intimate connection to the platform of the abutment, not the implant, and involve platform switching for better bone retention and emergence profile.

What is platform switching in the context of bone level implant restorations?

Platform switching in bone level implant restorations refers to the abutment going into the interior of the implant, allowing for better bone retention and avoiding micro-gaps, which helps in achieving a better emergence profile.

What are the four kinds of abutments mentioned in the script?

The four kinds of abutments mentioned are cementable, screw retained, stock, and custom abutments.

How are cementable abutments typically used in restorations?

Cementable abutments are used by cementing or bonding the restoration to the abutment, similar to how a conventional crown is attached to a natural tooth.

What is the advantage of using screw retained abutments over cementable ones?

Screw retained abutments are advantageous because they avoid the use of cement, which has been identified as a primary cause of peri-implantitis, a condition affecting implant health.

What are stock abutments and how are they used?

Stock abutments are prefabricated and screw into the implant, allowing for an abutment level impression. They are the simplest kind of abutment to use but require ensuring adequate restorative space before placement.

How are custom abutments different from stock abutments?

Custom abutments are either milled or waxed and cast to fit a specific patient's needs. They are made to fit an implant model from the mouth, providing a more precise fit compared to stock abutments.

What is the purpose of the 'chimney' in custom abutments for bone level implants?

The 'chimney' in custom abutments for bone level implants is a part that is milled to mimic a tooth preparation. It is cemented to the base abutment, and the crown is then fabricated to fit this milled part, allowing for a precise and customized fit.

What are some other types of abutments mentioned for specific restorations like bar retained overdentures or hybrid restorations?

Other types of abutments mentioned include those for screw retained restorations, which may need to be angled to create a path of insertion for larger restorations like bar retained overdentures or hybrid restorations.

Why are temporary abutments used in implant dentistry?

Temporary abutments are used to fabricate long-term provisional restorations, especially when the provisional restoration is intended to help develop tissue contours before the final restoration is placed.

Outlines

00:00

🦷 Introduction to Abutments in Implant Dentistry

This paragraph introduces the topic of abutments in implant dentistry, emphasizing the complexity of choosing from the vast array of abutment options available. It outlines the importance of understanding the different types and their indications, such as straight, angled, stock, and preppable abutments. The speaker aims to demystify the selection process by categorizing abutments into tissue level and bone level implant restorations, explaining the intimate connection of the restoration to the implant platform in each case. The paragraph also introduces the concept of platform switching in bone level restorations, which is beneficial for bone retention and avoiding micro gaps.

05:01

🛠 Stock and Custom Abutments for Implant Restorations

This section delves into the specifics of stock and custom abutments, explaining their uses and advantages in implant restorations. Stock abutments are prefabricated and can be straight, angled, or preparable, suitable for both tissue and bone level implants. Custom abutments, on the other hand, are tailored to the patient's needs, either milled or cast to fit the specific implant model. The paragraph highlights the use of cementable stock abutments for tissue level implants and the customization options available for bone level implants. It also discusses the process of creating custom abutments, such as the Variabase abutment in the Straumann system, which involves milling a 'chimney' that is cemented to the base abutment and then cemented with the crown.

10:02

🔩 Screw Retained Abutments and Their Applications

The final paragraph focuses on screw retained abutments, which are used to avoid cementing issues that can lead to peri-implantitis. It describes how these abutments work for both tissue and bone level implants, with the crown or bridge milled to fit directly onto the abutment and then secured with a screw. The paragraph also covers the use of angled abutments for creating a path of insertion in larger restorations, such as bar retained overdentures or hybrid restorations. Additionally, it mentions other types of abutments like overdenture abutments and temporary abutments used for fabricating provisional restorations. The speaker advises consulting with implant representatives and laboratories for guidance on selecting the appropriate abutments due to the vast number of options available.

Keywords

💡Abutments

Abutments are the components used in dental implant procedures that connect the implant to the restoration, such as a crown. They are essential for supporting the artificial tooth and ensuring a proper fit. In the video's context, different types of abutments are discussed, including their indications and how they relate to tissue level and bone level implant restorations.

💡Implant Restorative Dentistry

This term refers to the dental specialty focused on restoring the function and aesthetics of the mouth using dental implants. The script discusses the complexities faced by restorative dentists when choosing the right abutments for implant restorations, emphasizing the importance of understanding various abutment types.

💡Tissue Level Implant Restorations

Tissue level implant restorations are a type of dental implant where the crown or abutment directly covers the implant platform, creating an intimate connection. The script explains how this type of restoration is distinguished from bone level restorations and how the abutment's collar is covered by the restoration.

💡Bone Level Implant Restorations

Bone level implant restorations differ from tissue level in that the restoration connects to the platform of the abutment rather than the implant itself. This method, sometimes referred to as platform switching, is highlighted in the script as a way to achieve better bone retention and emergence profile.

💡Platform Switching

Platform switching is a technique used in bone level implant restorations where the abutment's platform is smaller than the implant platform. The script mentions its benefits, such as improved bone retention and avoiding micro-gaps, which can lead to better long-term outcomes for the implant.

💡Cementable Abutments

Cementable abutments are those to which the dental restoration is cemented or bonded, similar to how a conventional crown is attached to a natural tooth. The script discusses their common use in single-unit restorations and as an alternative to screw-retained abutments to avoid potential issues related to cement around implants.

💡Screw Retained Abutments

Screw retained abutments have a restoration that is screwed into the implant, with a hole through the restoration that is typically filled with composite to blend with the restoration. The script notes their frequent use, especially in avoiding cementation issues and in hybrid or bar-retained restorations.

💡Stock Abutments

Stock abutments are prefabricated and screw into the implant, allowing for an abutment-level impression. The script describes them as the simplest kind to use but also notes the necessity of ensuring adequate restorative space before placement.

💡Custom Abutments

Custom abutments are specifically fabricated for a given patient, either milled or cast to fit the model of an implant from the mouth. The script emphasizes their use in achieving a precise fit and optimizing the emergence profile and tissue management.

💡Prefabricated

Prefabricated refers to items that are manufactured prior to being ordered, in this case, for dental use. Stock abutments are an example from the script, being ready-made and used in implant procedures without the need for custom fabrication.

💡CAD/CAM

CAD/CAM stands for Computer-Aided Design/Computer-Aided Manufacturing, a technology used in dentistry for designing and fabricating dental restorations. The script mentions CAD/CAM in relation to custom abutments, where a 'chimney' (part of the abutment resembling a tooth preparation) is milled and cemented onto the base abutment.

💡UCLA Abutment

The UCLA abutment is a specific type of custom abutment that allows for a metal abutment to be waxed and cast, with a gold coping at the bottom. The script describes its construction and use in creating screw-retained crowns and bridges, highlighting its versatility in implant dentistry.

💡Hybrid Restorations

Hybrid restorations are dental appliances that combine features of both fixed and removable prosthodontics. The script discusses the use of screw-retained abutments in hybrid restorations, where the abutments are angled to create a path of insertion for components like a bar in an overdenture.

Highlights

Abutments are essential components in implant dentistry with hundreds of choices available, making it one of the most confusing aspects for restorative dentists.

Different types of abutments include tissue level and bone level implant restorations, each with unique indications and connections to the implant platform.

Tissue level implant restorations require an intimate connection between the crown and the implant platform, either directly or through an abutment.

Bone level implant restorations involve an intimate connection between the restoration and the platform of the abutment, not the implant, allowing for better bone retention and emergence profile.

There are four main kinds of abutments: cementable, screw retained, stock, and custom abutments, each serving different purposes in implant restoration.

Cementable abutments are used similarly to conventional crowns, cemented or bonded to the abutment for single units or bridges.

Screw retained abutments avoid cementing issues, with restorations fabricated to be screwed into the implant, reducing the risk of peri-implantitis.

Stock abutments are prefabricated and allow for an abutment level impression, requiring adequate restorative space before placement.

Custom abutments are milled or cast specifically for a patient, fitting an implant model or scanned impression for optimal fit.

Cementable stock abutments for tissue level implants come in straight, angled, and preparable options, suitable for various restoration placements.

Bone level implants may use stock abutments that are straight, angled, and available in titanium and zirconia, but are less common due to the advantages of customization.

Cementable custom abutments are designed to mimic tooth preparations, optimizing emergence profile and tissue management.

The Straumann system, used as an example, offers variabase abutments with specific shapes for laboratory milling of the 'chimney' portion.

Custom abutments for tissue level implants, such as the barrier-based abutment, cover the implant platform completely before cementing the crown.

The UCLA abutment is a custom option allowing for a metal abutment to be waxed and cast, with a gold coping for semi-precious metal casting.

Screw retained crowns and bridges use abutments similar to cementable custom abutments but with the crown milled directly onto the abutment and then cemented.

Angled abutments are necessary for larger restorations or when implant placement doesn't allow a path of insertion, as seen in bar retained overdentures.

Locators and other overdenture abutments provide retention for dentures, screwed into the implant for secure attachment.

Temporary abutments are used for fabricating long-term provisional restorations, particularly to develop tissue contours, with options for both cemented and screw-retained provisionals.

Implant representatives and laboratories are valuable resources for navigating the complex choices in abutment selection for optimal restoration outcomes.

Transcripts

[Music]

the second lesson in implants 101

is about abutments we're going to help

you understand the types of abutments

and understand the indications for

different types of abutments

literally there are hundreds of abutment

choices with each system

every implant company has multiple ways

to put something on top of their implant

and it probably is one of the most

confusing things that the restorative

dentist has to face

when they're doing implant restorative

dentistry there are different shapes and

sizes there are different indications

they're straight they're angled they're

stock they're preppable

so how do you make that choice we're

going to sort through all of these

and hopefully make this less confusing

let's think about different categories

we know that there are tissue level

implant restorations in bone level

implant restorations and there's a

difference between the two

so one of the things that we need to

understand is that in the

tissue level implant restoration there

is an

intimate connection to the platform of

the implant

either the crown fits directly over the

top of that

implant platform or the

implant abutment fits directly over the

top of that implant platform

notice in the photographs there's a

tissue level implant

analog in a model and then you can see a

photograph of the crown

that crown has a metal abutment that has

been

attached to it that fits directly on top

of the implant platform

so that entire collar that silver collar

on the tissue level abutment

is covered by the restoration

bone level implant restorations are

different in that

the the restoration has an intimate

connection to the platform of the

abutment not the implant the abutment

goes

into the interior of the implant which

is sometimes called platform switching

it allows for much better bone retention

it helps us avoid what's called micro

gap

and allows for better emergence profile

as the abutment comes out of the

platform

so in the first radiograph you'll notice

that the abutment is screwed

into the implant it's shaped much like a

tooth preparation would be shaped

you can see the margin the crown is then

bonded or cemented to that implant

abutment

much like you would bond or cement a

crown to a natural tooth

so there is no connection of the final

restoration to the implant

there are four kinds of abutments that

we need to think about

there are cementable and screw retained

in cementable abutments the restoration

is cemented or bonded to the abutment

just like you would a conventional crown

to a tooth most commonly

we use a cementable abutment for a

single or sometimes one two or

three units that aren't splendid

together sometimes they're used for

bridges

screw retained abutments have a

restoration that's fabricated so that it

is screwed into

the implant there's a hole through the

restoration that must be

filled usually with composite so that it

blends with the restoration

it's used most frequently to avoid

cementing because we're learning

recently in the past few years that

cement around implants is a primary

cause of peri-implantitis

screw retained abutments are also used

in hybrid restorations or in

bar retained overdentures two other

categories of abutments are stock

abutments and custom abutments

stock abutments are prefabricated

abutments that screw into the implant

and allow what's called an abutment

level impression

meaning that the abutment goes into the

implant permanently at the time the

restorative dentist places it

this is probably the simplest kind of

abutment to use

however it does require making sure that

you have adequate restorative space

before you place the abutment in the

implant

custom abutments are either milled or

waxed and

cast so that they are they're fabricated

specifically to a given patient they'll

fit a model

of an implant from the mouth just as you

would a conventional

crown impression or perhaps from a

scanned impression if you're using

in-office milling or in-office scanning

so let's look at each of these

categories

cementable stock abutments for tissue

level implants

look something like this there are three

different kinds there's a straight

abutment

screws directly into the implant great

for posterior

restorations where the implant is

appropriately placed

there's an angled abutment that changes

the direction

of the abutment relative to the

placement of the implant

so if you have an implant that's placed

a little too far buckle a little too far

lingual you can placed an

angled abutment that allows the the

restoration to be fabricated more

appropriately

the third type of stock abutment is a

prepable abutment

the abutment is screwed into the implant

or into an

implant analog an analog is a replica of

the implant

and then that titanium abutment is

actually prepped

to fit the the circumstances of that

individual tooth

bone level implants also have stock

abutments

they're straight and angled and they

come in both titanium and zirconia

there's also a prepable abutment for

bone level

implants we seldom use

stock abutments in bone level implants

one of the great advantages of the bone

level implant

is that it allows us to customize the

abutment

to most appropriately fit the tissue

profile and the circumstances that that

patient brings to us

using a stock abutment on a bone level

implant makes it very

difficult to get optimal results when

we're thinking about

bridges or fixed there are also

cementable abutments

they have a little bit different

configuration

the the abutments on the screen are for

tissue level implants now remember these

abutments go down and completely cover

the platform of the implant so

the restoration is then cemented on top

of these abutments

there's also a preppable abutment for

bridges

works the same as for single

restorations and for

bone level implants with bridges or

short span fixed appliances

there are also a series of cementable

abutments stock abutments

that are the same as for single

restorations

straight angled and preparable and

they're also available in

zirconia let's talk about custom

abutments that are

cementable custom abutments are those

that are either

milled or waxed so that they mimic a

tooth preparation they help us optimize

emergence profile they help us better

manage

tissue because those abutments can be

milled or waxed and cast

to fit the exact tissue profile that we

as the restorative dentist help

establish

with healing abutments the image on the

screen

is a very obese abutment for bone level

implants

now the system that we're showing here

is a straumann system

and we're i'm doing that because it

happens to be the system that i'm most

familiar with

most comfortable with and have used for

the past 15 years

other systems may have different names

for similar kinds of abutments

in this particular case this variabase

abutment

has a specific shape so that the

laboratory

can mill what's called a chimney or the

part of the abutment that looks like the

tooth preparation

that milled chimney is then cemented

to the very base abutment the crown is

then fabricated

to that milled chimney

so the abutment is screwed into the

implant

it looks like a tooth preparation

the crown is milled to fit

the abutment and then is cemented to

place

the image on the screen shows a cad cam

rendering

of the chimney that is cemented onto the

abutment

abutment then is removed from the

implant analog and screwed into the

patient's mouth

the crown is fabricated at the same time

as the chimney is fabricated

and then is bonded or cemented to that

abutment there's also a very base for

tissue level implants

if you look at the image you'll see the

broad platform

at the bottom of that a barrier-based

abutment remember it's going to

completely

cover the tissue level platform

this this abutment works the same as the

bone level abutment the chimney is

milled to fit the top of the abutment

it's cemented in place

the crown is then milled or pressed

waxed and pressed so that it fits the

chimney

and then cemented in place in the same

way as the

bone level the ucla abutment is a custom

abutment

that allows a metal abutment to be

waxed and then cast the bottom of the

abutment is a

gold coping so that you can cast

a semi-precious metal to this gold

coping

the white top part is a waxing sleeve

it allows the screw access to be left

open

these are examples of ucla abutments on

top of bone level

implants screw retained crowns and

bridges

have abutments that work the same way as

the cementable custom abutments

the difference here is instead of

fabricating a chimney that's cemented to

the abutment

the crown and sometimes the bridge is

milled to fit directly on the abutment

and then cemented to those abutments

there's a hole through the center of the

restoration that allows access to place

the screw

that hole then is filled with composite

they can be used both for tissue level

and for

bone level implants it's the same

abutment essentially

here's an example of some posterior

single units

that are going to be screw retained you

can see the opening

through the center of the crown where

the screw will go

and that opening will then be filled

with composite

there are other types of abutments for

screw retained restorations

when we're using multiple implants for

something like a bar retained over

denture or a hybrid or a multiple unit

bridge

sometimes the placement of the implants

doesn't allow

a path of insertion so the abutments

that are placed on top of those implants

need to be

angled in order to create that path of

insertion

the images on your screen are examples

of straumann screw retained abutments

that are made specifically for larger

restorations

you can see in this particular case

which is going to be a bar retained over

denture

that there are five different kinds of

abutments in this mouth

some of the the implant angles were

tilted

in order to take advantage of of

existing bone

in order to create a path of insertion

for the bar on the other side of the

screen

those angled abutments had to be placed

then an

impression is made of those abutments

and transferred to the lab so that they

can fabricate the bar

other abutments include things like over

denture abutments like

locators these are screwed into the

implant

and then the denture is used to pick up

the retention part of the

locator there are also

temporary abutments that we can use to

fabricate

long-term provisional restorations

specifically if we want to use the

provisional restoration to help develop

tissue contours there are two different

kinds there's the prepable

peak abutment which is a plastic-like

material that's actually prepped and

polished

probably best used for cemented

provisionals

and then there's the stock abutment this

can be cut to length

and then used as a screw retain

provisional

while they both can be screw retained

it's easier to do a screw retained

provisional restoration with the stock

abutment

so i hope that clears up some of the

mystery around abutment selection

one of your best resources is your

implant rep and your laboratory

because sometimes it's really difficult

to sort through

all the hundreds of choices i've

discovered that it's best to go to the

source

and to talk to people who use them every

day and are most familiar with their

applications

if you're working with a great

laboratory that does a lot of

implant retained restorations

they can help you choose abutments and

as i said your implant representative

should be well trained to help you do

the same thing