TYPES OF ABUTMENTS

The selection of the implant abutment for each individual patient case is an important part of the implant-prosthetic treatment phase.

STOCK  VS CUSTOM ABUTMENTS

Implant abutments can be either standard or customized. The use of a standard abutment is indicated if the implant is placed in an almost ideal prosthetic position. The advantages of standard abutments are time efficiency in the overall treatment and therefore shortening of the technical manufacturing time.

The implant evolution has become a "restorative driven" field, and it is therefore important to know the designing principles of custom abutments, advantages, and its connection to the implants. The key is to have an optimum selection for designing of the implant position and angulation in the clinical scenario.

Stock implant abutments are manufactured to standard sizes and can be used on both tissue level and bone level implants. They are designed to be user-friendly, to make impressions with ease, are the most economical and are typically used for cement retained restorations. They can be both straight and angled. They are best used for tissue level implants that are not in the esthetic zone.

The downside of stock implant abutments is that the tissue will conform to the shape of the implant abutment; if used in the esthetic zone, it is very difficult to for the ceramist to achieve optimal emergence contours and to have the tissue support be optimal relative to adjacent teeth. The other challenge is that the final margin placement of the crown cannot be precisely controlled - it is dependent on the depth of the implant and the height of the abutment.

On the other hand, custom stock abutments are designed to a precise position relative to the crest of the tissue; they can be used for either bone level or tissue level. There are many options for custom abutments, some are universal based upon a coping that is cemented, others are milled from a titanium or zirconia blank and some are simple tubes upon which a wax-up is performed.

• Benefits of Custom Abutments:

• Create a natural emergence profile between an implant and crown

• 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

ANGULATED ABUTMENTS

The angled abutment may be considered a suitable restorative option when implants are not placed in ideal axial positions.

To select a degree of the abutment measurements included probing depths, gingival level, gingival index, and mobility must be considered.

By utilizing the angular abutments the surgeon can place multiple implants at divergent angles to utilise available bone morphology and volume, avoiding anatomical structures, and achieve parallelism of the adjustable abutments for aesthetic and mechanical connection to the prosthetic structure. 

HEALING ABUTMENT

Healing abutments are small dome shaped metallic cylinders that are placed above the gums and over the fixation screws."It is made out of titanium or titanium alloy with parallel, concave or tapered walls determined by and range in height from 2 to 10 mm (height depends upon the thickness of tissue present )