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the clinical advantages of custom Abutments for implant cases. This is understandable given the ease of maintaining an inventory of stock abutments and the assumption that custom abutments are prohibitively expensive. Plus, clinicians have successfully restored implant cases for years with stock abutments. So why switch? After spending 38 years restoring implant cases with stock abutments, I was reluctant to switch. I had grown accustomed to having my own lab with two experienced technicians. They would take stock abutments and modify them according to the soft tissue model. Though this protocol produced successful outcomes, my practice was spending valuable resources modifying prefabricated components. In addition, the peri-implant tissue, which had healed around the generic shape of stock healing components, did not conform well to the contours of the final abutment, making delivery of the final restoration more difficult and the experience less comfortable for the patient. I frequently had to make chairside adjustments to the abutments to achieve the proper fit and ideal emergence profile I demand of the cases I restore, requiring additional chair time. Death of the Stock Abutment? Since last May, I have been restoring my implant cases with custom abutments and all-ceramic crowns and bridges designed and fabricated by the dental laboratory utilizing CAD/CAM software. The results have been eye-opening to say the least. The fit and contours of the final custom abutments have been close to perfect, adhering nicely to the soft tissue architecture sculpted by the custom components used during the healing phase and requiring very little to no chairside adjustments (Fig. 1). Additionally, the final abutment margins of these restorations demonstrate exceptional support of the soft tissue immediately upon placement (Fig. 2). This result is created by custom abutments during the healing phase, which train the soft tissue to achieve optimal gingival contours and help establish ideal emergence profiles (Figs. 3, 4). Figure 1: Final custom abutment immediately following delivery. The abutment seated perfectly and required no chairside adjustments, adhering nicely to the gingival architecture and margins established by the custom healing abutment. Figure 2: Final custom abutments, milled from titanium using CAD/CAM technology, exhibiting tremendous support of the soft tissue around the margins of the abutments. Many doctors are hesitant to transition to custom components, having spent years — even decades — utilizing stock abutments for implant cases. 3 4 Figures 3, 4: By the time the final custom abutments (top) and crowns (bottom) are delivered, the custom healing abutments have established optimal emergence profiles for the restorations, illustrated by the natural fit of the final restorations for tooth #29 & #30. 30 – www.inclusivemagazine.com –
Custom components begin guiding a case toward a predictable outcome from the very beginning, after an implant is placed. During the healing phase, the patient-specific contours of a custom abutment sculpt the peri-implant tissue to accommodate the final restoration, setting up a smooth and atraumatic transition when the time comes to deliver the final custom abutment and crown (Figs. 5–7). Final custom abutments are available in several materials, including zirconia, titanium and zirconia with a titanium base. Though there is considerable and ongoing debate over the advantages of zirconia versus titanium, zirconia abutments offer esthetic advantages for patients with a thin tissue biotype and for cases in the anterior. Zirconia abutments allow for restorations where the gray color of metal does not show at the gingival margins or through the soft tissue, which is a key consideration for cases in the esthetic zone (Fig. 6). Additionally, crowns and bridges can be fabricated with more translucency when a tooth-colored foundation is used. Regardless of which material is used, the abutment height, margins, contours and emergence profile are designed and milled with precision using CAD/CAM technology to meet the needs of individual patients. 5 During the healing phase, the patient-specific contours of a custom abutment sculpt the peri-implant tissue to accommodate the final restoration, setting up a smooth and atraumatic transition when the time comes to deliver the final custom abutment and crown. 6 7 Figures 5–7: Even when patients present with severe gingival trauma (top) — in this case, damage from a bicycle accident — custom healing abutments effectively sculpt the gingiva to adhere to the parameters of the final restoration and facilitate optimal healing. By the time the final restorations are delivered, the contours and margins of the peri-implant tissue have been trained to accommodate the final custom abutments (middle) and crowns (bottom). By eliminating concerns about metal showing through the gingiva, custom abutments fabricated from zirconia (middle) are an especially attractive option for cases in the esthetic zone. – The Clinical Advantages of Custom Abutments – 31
Page 1 and 2: Inclusive Restorative Driven Implan
Page 3 and 4: Contents 9 20 29 36 Implant Q&A: An
Page 5 and 6: Letter from the Editor This issue o
Page 7 and 8: ■ JACK A. HAHN, DDS Dr. Jack Hahn
Page 9 and 10: Online Exclusive R&D CORNER “Digi
Page 11 and 12: Implant& Q A: Go online for in-dept
Page 13 and 14: DC: We often hear that endodontics
Page 15 and 16: markets have been highly penetrated
Page 17 and 18: get fibrous encapsulation. By going
Page 19 and 20: type they were. And what was wrong?
Page 21 and 22: The young dental professionals of t
Page 23 and 24: Go online for in-depth content Mini
Page 25: Courtesy of Christopher P. Travis,
Page 28: When I reached out to Dr. James, he
Page 34 and 35: the clinical advantages of custom A
Page 38 and 39: educing treatment time with digital
Page 48 and 49: System-specific intraoral workflow
Page 51 and 52: Go online for in-depth content BRID
Page 53 and 54: 1 2 6 7 Figures 1, 2: Preoperative
Page 55 and 56: Figure 21: A polyvinyl siloxane imp
Page 57 and 58: Clinical Case Report Go online for
Page 59 and 60: would be designed and milled from t
Page 61 and 62: Figure 13: Inclusive Custom Tempora
Page 63 and 64: A panoramic radiograph was taken wi
Page 65 and 66: Discussion Several types of technol
Page 69 and 70: Optical Impressions and Full-Arch I
Page 71 and 72: The final restoration was fabricate
Page 73 and 74: Figure 9: The VDO was measured prev
Page 75 and 76: LAB SENSE Go online for in-depth co
Page 77 and 78: Figure 1: The Screw-Retained Hybrid
Page 81 and 82: CLINICAL TIP Managing Implants in P
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