Ronda asks us:
My 18 year old son was in a car accident and needed his 4 top front teeth replaced. He has had bone grafted and the
dental implants are in. My question relates to his abutments.
I have heard that there are different types of abutments on the market. Upon doing some research I have also noticed that there are companies that are utilizing advanced computer-imaging in the design of abutments. My question is whether there is really any benefit of one abutment over another? How great is the advantage of computer-generated abutments vs. standard
abutments? Thanks for any help.
The ultimate esthetic success of the crowns on your son’s front teeth is largely determined by the position of the implants. Often however, implants cannot be placed into the ideal position. A non-ideal postion can be substantially improved with a custom abutment. The bottom line is your son will be best served with an experienced and reputable restorative dentist and implant surgeon. The implant surgeon, with guidance from the restorative dentist, will place the implants in the most ideal position possible. Once placed, the restorative dentist will determine if stock abutments are adequate or whether custom abutments will provide a superior result. My advice to you: Do not concern yourself so much with the abutment choice but rather with the selection of your restorative dentist and surgeon.
Dear Ronda:
If implants are correctly placed and gum is well managed , many abutments will be suitable.
I will almost allways select zirconia abutments over titanium ones.
In my opinion 4 good zirconia abutments will give your son a long lasting and beautiful smile.
There are some advantages in the use of cad abutments but as I said if implants are correctly placed there will be no real need for them. If there is need for corrections, well… cad abutments made of zirconia is the way to go.
good luck
Dear Ronda, The doctors before me stated it correctly, your first decision is to get the right doctor, in my opinion over 7000 dental implants later, is find a highly qualified prosthodontist in your area,
in addition as much as I love zirconia( tooth colored Abutments) i have had much experience with computer generated abutments in the anterior as well as posterior area, 106 to be exact.. and i must say they are better than any other pre-fab or custom abutment i have ever used…. right now in our practice every implant abutment placed in our patients is of computer generated, mainly because it’s the most ideal position… because it’s calculated by a copmuter…that doesn’t mean in your son’s case any pre fab will not work… this is just my biased opinion… just thought i would share it with you… i hope your son has a spedy recovery… if you would like to discuss it further you can email me at drdean17@aol.com…
Dear Ronda -
Sorry to hear about your son. However, the condition that you describe with your son is not that uncommon unfortunately. But fortunately, it can be successfully treated with implants. As per the previous remarks, the most important aspect is the planning for the case. My recommendation is to get a CT scan to determine the actual amount of remaining bone, so that the implant sites can be properly determined in three dimensions. Once this is accomplished, the appropriate implant and abutment can be chosen.
While there are many advantages for CAD CAM abutments, design, strength, soft tissue support, emergence profile, etc., it is most important that your son’s implants be correctly placed so that they have a chance to last his lifetime, while maintaining esthetics and function.
The only diference between the two types of abutments its the price. The most important work is on the back of the implantologist and the prosthetic tecnician. The Cad-Cam is another way to create necessity for buying and spend more money and think that will reduce our mistakes!! Wrong !!!
Dear Ronda -
Sorry to hear about your son and about the fact that implants are already in place, while the decision regarding the type of abutments has not yet been made. I agree with Dr. Ganz above that generating a three-dimensional CT data set before surgery would have been a very good approach to this situation. I’d sure like to know what “pre-surgical” planning was done, and what esthetic and functional outcome possibilities were evaluated diagnostically. After all, it is the final esthetics and function required to rehabilitate your son’s dentition that allow the treatment team (surgical specialist, restorative dentist, dental lab) to determine the best suitable final restorations. And it is the volume of each crown restoration that dictates the space available for each abutment, which by the way will work fine both ways: Custom-made in a dental laboartory, or via CAD/CAM procedures. Good Luck!
18 years old? It is not a nice age to begin with implants, since we have a data of 40 years.Be sure that your son is in the cuspid of technology and knowledgement.
My only concern would be only the doctor,but there are too many .
One advice:Go to one doctor and say that money is not the problem….you will hear wonderful things!
It is unfair to say a prosthodontist is needed. A general dentist with experience can handle the case. In my opinion, custom abutments are ideal for anterior cases such as your son’s.
feedback from Dr. Ganz , Wow!
you have alot of experience with CAD CAM. If there is a case
if its several implants were placed, from lateral incisor to 2nd premolar, im-plants placed more towards the palate, angulation is not optimal.
You want esthetics and money is not an issue, would you go ahaead with the zirconia and splint them or go with gold and splint them?
If zirconia with what all ceramic system would you restore it with taking into consideration splinting the zirconia abutments?
what would you recomend in the choosing in the prescription type of finishing line for multi unit cases in Atlantis?
Hi,
I am just going to start the whole process of an implant. I would like to know if there is too much difference between the custom abutment and the prefab abutmente. I know the first difference is the price, but what about quality?
Maris, The quality of both are great. You have to trust your Doctors decision. They are trying to meet your aesthetic requirements. They bothe work well, it depends on the situation.
My inplant dentist wanted to insert regular abutements, my cosmetic dentist said he wants to instal custom abutements, is this a case of 2 dentists fighting over the busines or is one better for me?