Preparing the Abutment

Dr. Aaron asks:

For some of my more apprehensive dental implant referrals I place the solid abutment onto the dental implant for them, allowing them to take a conventional crown and bridge impression for the crown.

I usually prepare the abutment outside the mouth, then try it in the
mouth until I am satisfied with the occlusal clearance/countouring. My
question is: Instead of preparing the solid abutment outside the mouth,
can I prep the abutment while it is attached to the dental implant? I have
seen it done routinely in books and journals, but I am unfamiliar with
the technical considerations and/or things to avoid. Thanks for any help.

17 thoughts on “Preparing the Abutment

  1. I do this for many years without problems. just be sure to have a good cooling spray. my main fear in doing this is to overheat all the system. of course it is also preferable to work with a high-speed turbine and not with a red contra angle that provide more vibrations. good luck

  2. Response to Dr. Aaron. Good technique. As a G.P., I am sorry there are still so many restorative docs uncomfortable with implant dentistry. Since 1985 I have only had 2 abutments placed by surgeons. Having said that, your technique of preparing outside the mouth, then torquing, is great. One problem occurs that with the Straumann system at least, metal analogs cannot be used if the abutment is prepared. A better technique is to take the final impression WITHOUT preparing it. Then the lab can use metal analogs. They can then reduce the analog, make a reduction coping to send back with the crown. The restorative doctor can then reduce the abutment in the mouth with lots of coolant as you said, and cement the crown. If temporization is required, still take the impression, reduce the abutment minimally to place a temporary. The lab will still make the reduction coping, the restorative doctor will further reduce it at the time of crown cementation, and life is good.

  3. There is no doubt preparing abutments extra orally is always better, as mentioned in other comments to avoid over heating of implants and embading little tiny titanium particles inside soft tissues.
    only thing I would do differently is, instead of trial and error methods for abutment preperation mount the models on articulators in office.
    Preperation can be done in one shot,it will be very easy to make multiple abutments perfactly parallel.

  4. preparation of implant abutment in pt. mouth has some advantages and disadvanteges ,advanteges are quick one visit prep. impression,and temp.,reduce lab cost.,evaliwate clinical reduction.fresh bur in high speed and lot of cooling water is needed ,technique to be used is touch and move,avoid long touch with constant presure .disadvantage :soft t. problem to record impression.preparing abutment out side pt. mouth has some advanteges,and disadvanteges.advanteges are:reduce clinical time.,eliminate the fear of dameging the implant from overheat.,control subgingival margins.,disadvantiges are:more lab cost.,error in mounting implant analoge if impression post is not supported enough by impression material.,if undetected error in impression and cast process it may cost to change the abutment.doctor whatever you feel comfotabl with you can go for dr. ali

  5. If you use the Straumann Syn-Octa abutment system and take an implant level impression, you or your technician can adjust the abutments extra orally. Then you can seat the abutments and suprastructures and finish the case like C & B. All the above points are valid but if you want to minimize your time in the mouth Synocta and implant level impressions are the easiest in my hands.

  6. Aaron, you will find dental implant catalogues in which preparing the abutments intra-orally might damage osseointegration due to heat.
    Scientific data has no a direct evidence on studies describing this potential risk.It is sad that same catalogues,from the same Implant Companies do not alert clinicians about the risk of preparing the abutment in the mouth.
    1 degree over 37 C will alter the osseointegration and the more heat the less the capacity from the body to maintain the corporal-fluids levels.
    Even ,if you use irrigation…

  7. Several comments on prepping the abutments – (1) As mentioned it is always better to do this outside the mouth – to also achieve the best accuracy without the saliva and tongue getting in the way; (2) If you prep the abutment intraorally, and take an impression, you will not get an accurate result with this indirect technique because impression materials have been designed to impress teeth, and not metal; (3) years ago I came up with an Implant Abutment Preparation Kit offered by Brasseler… to give us the right tools for extra oral preparation (no financial interest); and finally, (4) Atlantis computer milled abutments now offer the ultimate solution.

  8. As an OMFS working with various levels of referral competency I see all kinds of patient handling. Most work on models but I have one well trained GP (Misch Institute) who routinely preps abutments in the mouth and in 10 years I have never seen a complication.

  9. I couldn’t agree w/Dr Ganz more, Atlantis is the answer for novice to expert. The ideal abutment everytime in everyway. World class implant dentistry is available to the masses at affordable fees. Ideal emergence, marginal placement, parallelism, taper and true anatomic form are all addressed by the technicians using the worlds most advanced dental software. Surgeons can take a stage 1 index and we can fabricate duplicate abutments and a temporary for placement at stage 2. The models with the 2nd abutment are returned to the restorative dentist for crown fabrication after the tissue has matured. If the margins need to be modified due to unforeseen tissue pullback then the 2nd abutment is altered at the lab before fabricating the final crown. The final restoration can be delivered in 15 minutes if no mod. to abut, 25 min if abutment needs to be switched out. What could be easier. We call the process SIMPL. For additional info go to http://www.betterimplants.com

  10. I think the ultimate solution for abutments used with cenent retained restorations would be one you can buy for under $100, with a pre-prepared, contoured margin at the right collar height, with the dip in the margin facing the labial for esthetics, and any needed angle corrections already incorporated into the abutment and pointing in the right direction and at the right degree of angulation.

    Several companies index the angle of their angled abutments to tip away from the flat of the hex or lobe of a tri-lobe connections (Nobel $207 Angled/$156 Straight), Zimmer ($165 Angled/$145 Straight), Implant Direct ($75 Straight or Angled, hexed or tri-lobe). This helps the process of aligning the dip of the margin to the labial and the direction of the angled abutment to the lingual. This requires the dentist aligning the flat of the hex or one of the tri-lobes, to the labial if you want the angle of the abutment to be directed to the lingual and the dip in the margin to be facing the labial. These same companies make abutments with contoured margins in various collar heights solving another aspect of the problem.

    Ultimately, these pre-prepared abutments can be attached to the implant and require so little preparation to achieve the same funtionality as an Atlantis or gold abutment. What often happens when dentists work in a team approach, is that the surgeon does not index the implant, the dentist does a transfer impression, and when the implant analog is located in the working cast, the lab can not use these stock abutments, necessitating use of Cad Designed or custom cast abutments that push the price of the abutment above $300. One solution that Implant Direct will be offering for the Tri-lobe connections is to offer straight and angled abutments with contoured margins with 4 rotational positions of the Tri-lobe base of the abumtent, allowing positioning every 30 degrees instead of every 120 degrees. This will allow the lab to start off with a stock abutment very close to the final abumtent, and then prepare the post to the disired shape thus saving both time and money over fabricating cast gold or Cad designed abutments.

  11. I would be interested in comparing fees for…cast gold abutments and for hi-nobel gold/porcelain crowns.
    What are your fees in other large cities across America??

  12. I too prepared for the past 15 years the abutment in the mouth in more than 90% of my cses and there never been a problem or a loss of bone
    lot of water ,assistant and extra care needed

  13. FYI – if you are in fact restoring a Straumann implant, using an abutment by another company – for instance, by Atlantis, will cause you to sacrifice a couple of things:
    1. the warrenty you have on those implants
    2. the precision fit that comes with the Straumann system
    just a thought…

  14. can you help
    i am a tech with a problem case.
    6 alpha bio implants that are way out of the ridge buccally on the maxilla.the implants could be best described as placed in the nose.
    i have to produce some kind of dolder bar in variation maybe with micro clips and over denture
    i have already tried but the patient needless to say complains that the teeth are too buccal placed.
    can anyone help!!!
    mike taylor

  15. obviously if implants are placed too labially, bar will be more labial and teeth and flange will be far too labial.
    it will create not only esthetic (buc teeth)but also functional problem and may lead to adverse lateral stress on implants.
    if problem is so big why not to remove implants graft the sites and come with better D&T.

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