Custom-Made Abutments ?

Catherine, I don't think I would panic if I were you. Probably what has happened in your case is that the margin of the gum around the implant is not in an ideal position for a standard abutment and a custom abutment is required to have an ideal margin. Perhaps your dentist may have explained it to you slightly differently but there is nothing out of the ordinary to make a custom abutment when circumstances dictate.There is usually no problems with the fit of custom made abutments, so functionally they shouldn't make any difference. They are usually a little more expensive however.

Catherine, That's great that you looked for an explaination. It is unlikely that the abutment did not fit the implant. Your Doc probabally did not explain his reasons clearly. More likely than not it was that the availble stock style abutments did not create the necessary flow from the implant to the area above the gums to allow your dentist to fabricate a well contoured naturally appearing crown. This is usually the reason that most of us use custom abutments. In fact I use them almost every thing to create a perfect result for my patients. You should be thrilled that your Doc noticed that a small change to a custom abutment will give both of you the result you are expecting. It usually is very little more in terms of cost and with all the time and effort you have both put in to this point it is well worth it. Best of Luck. Dr. Evan Tetelman Cleveland, Ohio

Catherine, I agree with Dr. Tetelman. I almost allways use custom abutments. The implant could be slightly off angle or the tissue too deep for a stock abutment to be usefull, and one of these conditions is so often the case that I plan for that possibility in the very beginning. If you try to make a stock abutment work you can get a less than optimal result. It could possibly been explained in a better was so as not to leave the question in your mind about the fit of implants and abutments, but it sounds like your dentist (and you) are on the right track. Dr. Dwight H Pate Auburndale, FL

I would like to know who is usually paid for the cost of a custom abutment? my dentist or the laboratory that made the abutment?

Dear Implant Specialists: I am delighted with your replies to patients who are wondering why custom abutments are necessary as, according to my oral surgeon, I need this type of abutment for my front tooth. Have a question for all of you. For almost 2 years I have been taking Fosamax for osteoporosis and I discontinued the medication during my tooth extraction and implant procedures. My dentist who is making the custom abutment and crown says I probably will need about 2 months to heal after the abutment is placed. Do you think it's OK for me to resume my osteoporosis medicine? Have you had problems with patients with osteoporosis and these custom abutments? Thanks! Patty

My dentist had custom abutments made and they weren't long enough--he installed them anyway. One simply couldn't hold the tooth, and the other he didn't screw in all the way so that he could get the tooth on it, but it only held for 5 months before it turned. He refuses to fix the abutments-- What can I do? Bear in mind that I already lost thousands of dollars to another dentist who used stock implants which didn't suit my case at all, and I had to leave him--he also refused to fix the abutments.

Dr. Tetelman is correct. As per the fit, if there is gum tissue btw the implant and abutment it would cause a poor fit. Also poor placement of the abutment by the Dr....which is an easy fix. If the custom abutment was made like a casted post and core-there could be problems. The reasons can go on as well as the solutions, but the majority are fixable.

I have the same issue noted by the other patients-received an implant on a front tooth. Abutment was discussed between surgeon and cosmetic dentist and I presume I got a standard abutment. Now, I'm being told I need custom. I still don't thoroughly understand why and at what point the dentist/surgeon should realize this. All I know is that I was given an estimate for the procedure and now may face up to $1,000 additional for a custom abutment. Is that a reasonable price? The surgeon charged me $2500 and the dentist is charging $2,000 for the crown. With the addition of the custom abutment my fee will be $5500 for one implant. Are these reasonable prices? Should I not have been warned about a possible $1,000 extra beforehand? There is little I can do about it at this point. Would just like to know for future reference. I feel I already paid for an abutment in one of these doctors fees. Thank you.

Dear Nancy, The fees are in line. If this is an anterior (front tooth), well these cases are tough from an aesthetic standpoint.

Question: I belong to a discount dental plan where I should recieve discounted prices for the procedures listed. I had two custom abutments including placements, done at the same time. The charges for it were $1850.00 total. Additional charges for two porcelain fused to metal (titanium)crowns were $2940.00 total. My dentist never expressed the price for the service however the discounted plan suggests lower prices. I think I have been taken! What would you suggest?

In many situations, custom abutments cannot be avoided as dental implant positioning depends also on the bone architecture.

My dentist states that the insurance charges them a fee? What the hell are they talking about? The fees are then just duplicated and I am told that I will be charged $1,249.00 and $1,249.00 if the dental plan does not pay.

John: I do not understand this myself. Perhaps your doctor ment to say the laboratory charges him, which they do. You may want to look over your insurance contract again! In my practice I keep insurance out of it. You submit the claim and pay me up front.