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Implant Fixtures and Abutment Considerations

03 Mar 2017 Michael Tischler, DDS
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The angle and platform height at which an implant is surgically placed can be corrected through various implant manufacturers’ components as well as by using custom abutments. Some implant companies have angle corrections built right into the implant fixture itself;
however, these require more exacting placement positions.

This month’s Implants Today topic is implant fixtures and abutment considerations. The choice of how a final prosthetic solution attaches to the dental implant(s) involves various factors and is a fundamental concept in implant treatment. The 2 main considerations for an abutment choice are (1) the angulations or platform height of the implant(s) and (2) the soft-tissue height around the implant(s).

The final prosthetic option, as determined by a properly prepared treatment plan, should dictate the positions and numbers of dental implants to support that prosthetic decision. This is called prosthetically driven implant dentistry. The abutment that connects the prosthesis with an implant can address the variability of a patient’s hard- and soft-tissue anatomy and is the buffer between a prosthetic goal and the patient’s hard- and soft-tissue anatomy.

The angle and platform height at which a im-plant is surgically placed can be corrected through various implant manufacturers’ components as well as by using custom abutments. Some implant companies have angle corrections built right into the implant fixture itself; however, these require more exacting placement positions. Multi-unit abutments are a way to correct the angle of an implant, allowing the screw hole to be redirected. Multi-unit abutments come in various angles and heights. The disadvantages of using a multi-unit abutment include the following: an additional microgap, increased costs, and a connection with the potential to loosen. Ultimately, ideal surgical placement should be performed to create optimal implant platform heights and angles based upon the desired prosthetic outcome.

The tissue height around an implant is also the result of the surgical technique used and correct treatment planning. If the ideal tissue height cannot be achieved after hard- and soft-tissue grafting and manipulation, then abutments can be used to bring an implant platform to a more coronal position. Ideally, an implant platform should be 1.0 to 3.0 mm below firm keratinized tissue. When an implant platform is more than 3.0 mm below the keratinized tissue, there is an increased propensity for soft-tissue problems and more pain with prosthetic try-ins. Ideally, it is better to achieve the correct platform height by employing correct surgical procedures than to gain that height through prosthetic parts (such as a tall multi-unit abutment).

In this month’s issue of Dentistry Today, we have a cover-featured article by Implants Today Advisory Board member, Dr. Jack Piermatti. Dr. Piermatti expertly discusses the details of different abutment choices in implant dentistry. Dr. Daniel Drake has contributed an article on the latest technologies in implant dentistry. Lastly, our editor-in-chief Dr. Damon Adams and I would like to announce the addition of Drs. Charles Babbush, Paul Fugazzotto, and David Little to our distinguished list of Implants Today Advisory Board members.

Also in Implants Today

Dental Implants in the Aesthetic Zone

Guided Implant Surgical Applications

Bone Grafting for Dental Implant Placement

Last modified on Tuesday, 07 March 2017 15:34
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