Understand Types of Implant Abutments and Their Uses
Summary
TLDRThis 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
🦷 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.
🛠 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.
🔩 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.
Mindmap
Keywords
💡Abutments
💡Implant Restorative Dentistry
💡Tissue Level Implant Restorations
💡Bone Level Implant Restorations
💡Platform Switching
💡Cementable Abutments
💡Screw Retained Abutments
💡Stock Abutments
💡Custom Abutments
💡Prefabricated
💡CAD/CAM
💡UCLA Abutment
💡Hybrid Restorations
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
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