Do I Need Custom Dental Implant Abutments?

There is a lot of confusion with patients that have come to me for 2nd opinions. The question is whether or not their dental implants need custom abutments or not.

 

I will try to make this as non-technical as possible. If you are confused, comment below and I will reply.

Most implants have three pieces. The implant that goes in your bone, the abutment the holds the tooth, and the crown tooth that attaches to the abutment.

  

 

In my practice the additional expense of a custom abutment is only necessary about 10% of the time. It can increase the cost of the dental implant by about 10%.

 

The best way to avoid making a custom abutment is for your implant to be placed correctly. Many implants are placed incorrectly at a incorrect angle and require a custom abutment to make it straight again.

 

Nothing beats a well-placed implant!

 

A well-placed implant allows me to use a pre-fabricated abutment and reduce cost to the patient. This type of abutment also has a better fit than a custom one since the titanium mating surfaces was manufactured to fit very tightly. Well made dental implants have a very tight connection between the implant and the abutment. This is very important for the long-term maintenance of your bone around the implant.

 

Here is case of the back molars replaced with dental implants and prefabricated abutments:

 

I use custom abutments for the following scenarios:

• An implant for an upper front tooth where the gum may be thin and the titanium would show through. (White zirconia abutment)
• The space between your upper and lower teeth is really small and the implant need to be held by a screw instead of by cement.
• Multiple or full mouth bridged dental implants.
• Overdentures that have a bar to hold them in.
• Excessively thick or thin gums.
• Excessively "scalloped" gums.

Here is a picture of a custom white zirconia abutment and the final crown that I made:

 

Sometimes the way the gum heals from the surgery may change an original plan for a prefabricated abutment to a custom one.

 

I teach classes to other dentists about dental implants. Most dentists are not aware when you should use a custom or prefabricated abutment.

 

As a Diplomate of the American Board of Oral Implantology (the highest certification acheivable), dentists and patients seek me out for education and opinions on what is the best treatment.

 

My goals are to simplify and streamline the procedure for patients. I do see an overuse of customized abutments when the prefabricated one would have been just as good or better.

Comments

[Dr. Andrew]

Beautiful coverage here...the pics are so descriptive...thanks a ton for this nice update it can almost be a study material.

[Morgan]

Dr. Amin,
I have a situation that I would appreciate in getting your professional opinion on.
Tooth number #19 I had an Implant that was placed incorrectly at an angel. Very uncomfortable because there is a big gap by the gum line between 19 & 20, food gets trapped all the time and there is a major gum recession on #20 which has become extremely sensitive to cold & Air . After I expressed my concern to the performing Perio, he suggested custom made Abutment in supporting the new crown that would fill the gap between 19 & 20…
In your professional opinion, would you say it would be better for me to go with custom abutment and new crown or have the implant removed and bone graphed again and redo the whole implant in its correct position????
After reading the information about custom abutment and the draw backs I am concerned that this may be a temporary fix rather than a permanent one. Btw, he also suggested in having gum Graf on facial of #20 to reduce the sensitivity..
Look forward hearing from you.
Morgan

[Dr. Ramsey Amin]

Hi Morgan,
The angle of placement of a dental implant is very important.

Unfortunately, without examining you, I can not tell you if it is a good plan.

Anyway to post some pictures or x-rays for me to look at?

Sorry,

Dr. Amin

[Morgan]

Dr. Amin,

I greatly appreciate your response to my email. Per your request I have a clear photo of the x-ray for your review but i would like to know how to send it to you.

Look forward hearing from you.

Regards,
Morgan