Internal Vs. External Hex?

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Dr. Kimbrow asks:

I know quite a few dentists who continue to use dental implants with an external hex.

However, now that the internal connection dental implants have been out for awhile, is
there any great advantage to using external hex? What are the issues here, on both sides? Why would you choose external over internal or vice versa?

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12 Responses to “ Internal Vs. External Hex? ”

• Alejandro Berg October 17th, 2006

  
  

  I have been doing this for 15 years and as most I started with external hex systems. Now I do both internal and external conection, there is really no difference in the results. I dont get many loose abutments(4 or 5 in all this time) so the only concern for me is what kind of implant is best for the patient. The restoring is the easy part if you placed it correctly. Again no real preference.

• Anonymous October 17th, 2006

  
  

  the advantage of the external hex is that there are more positions for the abutment

• Anonymous October 17th, 2006

  
  

  I would like the last post to please explain their comment regarding the increased nomger of abutment positions allowed with an external hex as opposed to an internal hex. When I last checked, a hex was a hex.

• Anonymous October 17th, 2006

  
  

  Sorry for the typo, that was the increased number of abutment positions

• Anonymous October 17th, 2006

  
  

  re: abutment positions, for angled abutments internal connection now has 12 positions rather than traditional 6.

• Snidero Vanni October 18th, 2006

  
  

  There are solutions for angled abutments internal connection with more than 12 positions. The main difference about internal and external connection, from my point of view, it is that if it’is not made a correct planning in the very complex surgical cases an elevated angle among the implants it can create some difficulties with the impression if you use inside connection

• Sreedhar Reddy October 18th, 2006

  
  

  Hi can any of you tell me about the variuos other types of attachments like the internal Octogon, Internal lobes and Morse taper and how they claim themselves better over the other? Or do you think each has a application in a given sitution can you explain how?. I would also be happy to know if there are any other types of connections other than the Internal/External Hex, Lobes, Octogon and Morse taper.

• Anonymous October 18th, 2006

  
  

  Let’s face it, internal hexed were adopted by the profession as it was easier to place the abutment and the screw. No more looking for screws in the mouth or possibility of swallowing (or worse)the abutment. Loose screws can be overcome by lingual screws (at a significant lab cost). External hexed implants give the best prosthetic combinations. There are a lot of prosthetic esthetic problems with internal retained abutment

• SMSDDSMDT October 19th, 2006

  
  

  Would you think that the internal hex style has a weaker head? Especially in the smaller diameters…Every internal hex system is an upsidedown external hex. Except for the solid abutments the weaker link would then be the abutment in an external hex system. If such is consistent logic the weak link would be more easily delt with. Once again when things are done well we just don’t have many issues at all… Most systems work extremely well. There are certain advantages with internal systems already mentioned . Ease of fit and .7mm less height to deal around.

• Alberto Miselli March 2nd, 2007

  
  

  Dear Fellows:

  I’m lookink for a External vs Internal Retainment Implant papers, where talking about vantage and disvantage, indications and contraindication.
  If someone can send via mail, I apriciate very much

  Thanks
  Alberto Miselli
  dentalmis@cantv.net

• dr.chowdhary April 29th, 2007

  
  

  hi, iam using exteranl hex since 4yrs, and have used internal as well, buti dont find any difference between internal nad external, yes abutment loosening i a problem which i have faced both in internal and external.as a prosthdontist i felt that external are more conveneant during impresion making.

• Keith Wilson August 30th, 2007

  
  

  There are some advantages of an internal hex over external hex. It is easier to get closure with an internal because the cover cap is usually flush with the implant platform at bone level. The external cover cap is over 1 mm in height to cover the hex and can be difficult to get primary closure. With an internal hex, ball abutments can have a shorter collar height for those with thin tissue. Ceramic abutments are stronger due to more material as well.

  The disadvantage of an internal is thin walls on smaller diameter implants. Threads do not come all the way up to the platform due to the thin walls. If you believe that implants loose bone to the first thread then this could be an issue.

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