PDF Download - Glidewell Dental Labs

Clinical Tip:
Placing Custom Healing Abutments
Go online for
in-depth content
by Bradley C. Bockhorst, DMD
For some cases, delivering a restoration on
an implant that has a standard, round healing
abutment can literally be the equivalent of putting a square
or triangular peg in a round hole. Integral to the Glidewell
Laboratories Inclusive ® Tooth Replacement Solution are the
components that help sculpt the peri-implant soft tissues.
Utilizing an anatomically shaped custom healing abutment
not only sets the stage for a superior restoration, but also
simplifies the restorative process, allowing for easier, complete
seating of the prosthetic components.
Custom healing abutments provide a superior option
to standard, round healing abutments if the case is not
going to be immediately provisionalized. The abutments
are fabricated from polyether ether ketone (PEEK), and
can be modified as needed. In cases where the soft tissue
is reflected, complete seating can be visualized and the
flap reapproximated and sutured into place around the
abutment. In flapless cases, the sulcus can be created
by various surgical means, such as a tissue punch of
appropriate diameter, a scalpel or a bur. In this case, a CO 2
laser was used. The model was used as a guide to remove
the tissue in the approximate transgingival shape of the
healing abutment. Complete seating can be confirmed with
a periapical radiograph.
When placing a custom healing abutment, the abutment
screw should be tightened to 12–15 Ncm. If space allows,
the screw access opening should be sealed to prevent food
and debris from accumulating in the screw access hole.
Cover the head of the screw with a cotton pellet, Teflon tape
or gutta-percha. Seal the opening with composite, acrylic or
a light-cure resin cement, as is demonstrated in this case.
For the final impressions, the screw can easily be uncovered,
and the custom healing abutment removed and replaced
with the matching custom impression coping.
The following case, courtesy of Dr. Dean Saiki, Oceanside,
Calif., illustrates this technique. IM
Figure 1: Custom healing abutment in place on the model
Figure 2: Laser-assisted gingivectomy prior to implant placement
Figure 3: Implant in situ
40
– www.inclusivemagazine.com –