IMPLANT ABUTMENTS

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
ABUTMENT
Portion of implant that supports and
retains a prosthesis or implant super
structure
TYPES
 Depending upon reten...
 Depending upon design
• Flat topped abutment
• Tapered shouldered abutment
• Direct gold copings
• Commercially availabl...
Cement retained abutments
• Better passivity
• Easier to obtain esthetics
• Fewer porcelain fractures – due to occlusal su...
Disadvantages
• Difficult to retrieve unless soft cements are used
• Abutments sometimes must be prepared
intraorally
• Gi...
Types of abutment for cement
retention
1.Single unit or one piece abutment
2 .Two piece abutment
1.Single unit or one piec...
Screw retained abutments
•
•
•
•

Low profile of retention
Less momentum of force
No risk of cement in the sulcus
Easily r...
Factors that affect screw connection
1. misfit
2. poor abutment screw tightening
3. excessive occlusal loading
4. settling...
Abutment for attachment
• Uses an attachment device to retain a removable prosthesis
• Includes
Mesostructure bars – conti...
www.indiandentalacademy.com
STRAIGHT ABUTMENT
-Indicated for replacing
single tooth for large prosthesis
upto full arch, implant borne
reconstructions...
ANGLED ABUTMENT
-available in angulations from 10-30
degrees
-improved esthetics
-To correct path of insertion
-Increase i...
• ABUTMENT DESIGNS
FLAT TOPPED ABUTMENT
-used to support bars for
overdentures/ fixed detachable hybrid
prosthesis
-Donot ...
TAPERED SHOULDERED ABUTMENT
-indicated in – bars to overdentures, hybrid overdentures,
single tooth replacement
-tapered d...
DIRECT GOLD COPING
-coping bypass abutment entirely
-consists of two parts- coping and screw
-porcelain is baked directly ...
Antirotational features of abutments
External hex
o Most widely available
o Found on top of abutments
o Hexagonal geometry...
SPLINE ATTACHMENT
Splines are fin to groove anti rotational design
Consist of six external components called tines which
p...
MORSE TAPER ATTACHMENT
-Consist of 1 piece abutment post with 5 degree taper
-resist rotation and even removal
-also refer...
Guidelines for abutment selection
• Depth of soft tissue

vertical height from implant
head to the gingival margin
 Meas...
• Emergence profile
 Need atleast 3mm of vertical space from implant head to
gingival margin
 Allows gradual transition ...
• Orientation
 Ideally implant is placed close to the long axis of missing
tooth (thro incisal tip or just palatally)
 S...
• Interocclusal space





Space from implant head to opposing tooth
Vertical space of 6-7 mm – standard abutment
5mm ...
ABUTMENT RETENTION
The retention of a fixed cemented
restoration – resist removal of the retainer
along the path of insert...
The tenets of retention and resistance include
• Abutment taper
– Retention of a crown decreases as the taper is
increased...
Abutment surface area
 There is linear increase in retention as the
diameter increase for preparation with identical
hei...
Abutment height
 A tall preparation offers greater
retention than a short abutment
 Increase in height – increases
surf...
 Abutment surface roughness

 Surface roughness increases the retention of a restoration by
creating micro retentive irr...
STERI OSS ABUTMENT
Central retaining
screw which fixes abutment
to implant after engaging the
external hex
PARAGON ABUTMEN...
CERAONE ABUTMENT
•
•
•
•
•
•
•
•
•

Components :
Implant coping
Abutment replica and healing cap
Gold abutment screw
Abutm...
- Designed for anterior maxillary
single tooth cementable porcelain
restorations
- Consists of implants with non
rotating ...
www.indiandentalacademy.com
- In posterior areas- ceraone
abutment is used with
ceramometal coping
- Since esthetics may not be critical
in posterior ...
• ESTHETICONE
ABUTMENT
- Noble biocare abutment
- hex shaped,tapered sides
- features a female hex which
interface with im...
- indicated in multiple implant
situation without causing
esthetic compromise with the
metal display
- designed to allow e...
• CERADAPT
ABUTMENT
- All ceramic alternative to metal
abutments
- Pre machined precision milled
abutment made to fit the ...
- Andersson and Oden showed
flexural strength of 690 MPA and
demonstrated that the abutment can
withstand tremendous loads...
• OCTA ABUTMENT
- Low profile component used with ITI implants
- Used in esthetically sensitive maxillary anterior region
...
• UCLA ABUTMENT
- Improved esthetics
- Gold alloy abutment screw
retention increases the
preloading force
- Abutment can b...
www.indiandentalacademy.com
- Each restoration has a tapered interface similar to that of a
standard FPD restoration
- Multiple butt joint prosthesis ...
• CUSTOM REANGULATED UCLA
ABUTMENT
-

Eliminates need for prefabricated angled abutment
Simplifies construction
Results in...
- Secured with titanium abutment screw
- Pre machined internal hex interfaces with implant male
hex provides maximum resis...
• NOBLE PHARMA SINGLE TOOTH
ABUTMENT
- Titanium abutment cylinder connects to the implant
fixtures
- Available in various ...
• MIRUS CONE ABUTMENT
- Used for multiple implant screw retained restorations
- Available with 1,2,3 mm collars
- Soft tis...
• BRANEMARK SYSTEM ANGULATED
ABUTMENT
•
-

Developed by Noble pharma
Designed to adjust access hole position,prosthetic
sc...
ASTRA ABUTMENT
• Presented with the option of 20 or 40 degree tapered top
• Used for fixed bridges / over dentures

www.in...
Abutment try-in kit
• Provide replicas of abutment types that can greatly assist
abutment selection
• Tried intraorally or...
• TREATMENT PLAN
• Single tooth implant abutment
•
•
•
•

Two piece abutment with straight emergence profile
Two piece abu...
• Fixed / fixed detachable prosthesis
 UCLA Abutments
 Similar custom cast abutments
• Hybrid bridge fixed detachable pr...
• Implant supported over dentures
•
Shouldered abutment that accepts a screw
retained bar / super structure attachments
•
...
JOURNAL REVIEW

www.indiandentalacademy.com
Removal of a fractured implant abutment
screw ( Ibrahim , JPD,June 2004)
Implant repair kit :
• Center bit
• 1.3mm twist d...
A locating splint for placing implant abutment
(Edmond , JPD , Jan 2004)
• After placement of abutment , a definite impres...
Computer generated Procera abutment
• Custom abutment-designed by a computer and machined
to exact specification
• Head of...
www.indiandentalacademy.com
Bibliography
•
•
•
•
•
•

Atlas of oral implantology – A.Norman Cranin
Contemporary implant dentistry – Carl.E.misch
Impla...
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Dental Implant abutments /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

Dental Implant abutments /certified fixed orthodontic courses by Indian dental academy

  1. 1. IMPLANT ABUTMENTS www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. ABUTMENT Portion of implant that supports and retains a prosthesis or implant super structure TYPES  Depending upon retention • Abutment for screw retention • Abutment for cement retention • Abutment for attachment  Depending upon angulation • Straight abutment • Angled abutment www.indiandentalacademy.com
  4. 4.  Depending upon design • Flat topped abutment • Tapered shouldered abutment • Direct gold copings • Commercially available – Steri oss abutment – Paragon abutment – Ceraone abutment – Ceradapt abutment – UCLA abutment – Noble bio care abutment – Estheticone abutment – Mirus cone abutment – Noble pharma single tooth abutment – Branemark system angulated abutment – Astra abutment www.indiandentalacademy.com
  5. 5. Cement retained abutments • Better passivity • Easier to obtain esthetics • Fewer porcelain fractures – due to occlusal surface integrity • Less fatigue • Manipulation in posterior region is easier with cement • Loosen less often compared to that of screws • Occlusal surfaces remain intact as there are no screw holes – better axial loading www.indiandentalacademy.com
  6. 6. Disadvantages • Difficult to retrieve unless soft cements are used • Abutments sometimes must be prepared intraorally • Gingival retraction may be needed • When permanent cements are used evaluation and maintainence of implants is difficult • Increase in the momentum of force www.indiandentalacademy.com
  7. 7. Types of abutment for cement retention 1.Single unit or one piece abutment 2 .Two piece abutment 1.Single unit or one piece abutment - does not engage anti rotational hex but fits flush with the implant platform 2 . Two piece abutment - has one component to engage anti rotational hex of implant body and other component to fixate the abutment and implant body together www.indiandentalacademy.com
  8. 8. Screw retained abutments • • • • Low profile of retention Less momentum of force No risk of cement in the sulcus Easily retrievable Disadvantages • Loosening of the screws • Difficult to obtain passivity • Difficult to obtain esthetics • Greater chances of porcelain fracture • Access in posterior regions difficult – risk of aspiration www.indiandentalacademy.com
  9. 9. Factors that affect screw connection 1. misfit 2. poor abutment screw tightening 3. excessive occlusal loading 4. settling of screws or abutment 5. inadequate screw design Misfit has been reported to be as high as 66 micrometer between implant and abutment in vertical direction , 10 degrees in rotational dimension and 99 micrometer in horizontal dimension Guidelines usually recommend the screw to be tightened by 50 – 70 % of yield strength www.indiandentalacademy.com
  10. 10. Abutment for attachment • Uses an attachment device to retain a removable prosthesis • Includes Mesostructure bars – continuous and non continuous Super structure attachments – magnets , custom clips , hader clips of plastic or gold , dolder clips , ceka attachments , zest , zag anchors , octalinks , o rings , ERA attachments , pin locks and lew attachments www.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
  12. 12. STRAIGHT ABUTMENT -Indicated for replacing single tooth for large prosthesis upto full arch, implant borne reconstructions - used only when emergence profile are parallel - if abutments are not parallel – can be prepared by • Direct method • Indirect method www.indiandentalacademy.com
  13. 13. ANGLED ABUTMENT -available in angulations from 10-30 degrees -improved esthetics -To correct path of insertion -Increase in angle – increase risk of fracture -placed as deeply as possible with most favourable axis orientation www.indiandentalacademy.com
  14. 14. • ABUTMENT DESIGNS FLAT TOPPED ABUTMENT -used to support bars for overdentures/ fixed detachable hybrid prosthesis -Donot engage antirotational component -advantage – simplicity - disadvantage - does not have counter rotational forces- unsuitable for single tooth replacement -straight emergence profileunesthetic in anterior maxilla www.indiandentalacademy.com
  15. 15. TAPERED SHOULDERED ABUTMENT -indicated in – bars to overdentures, hybrid overdentures, single tooth replacement -tapered design-resistance to lateral forces -lower profile abutment collars- subgingival margin – esthetic -tapered shoulder- angled at 9-15 degree www.indiandentalacademy.com
  16. 16. DIRECT GOLD COPING -coping bypass abutment entirely -consists of two parts- coping and screw -porcelain is baked directly on to coping – results in crown which attaches directly to implant body -coping engages antirotational component of implant Indications o Single tooth restorations that don’t require alteration of angulation o Limited interocclusal space o Minimal soft tissue thickness o Where subgingival margins are required www.indiandentalacademy.com
  17. 17. Antirotational features of abutments External hex o Most widely available o Found on top of abutments o Hexagonal geometry Internal hex o Provides more precise implant abutment interface o Disadvantage – screw loosening o Seats the abutment into hexagonal depression www.indiandentalacademy.com
  18. 18. SPLINE ATTACHMENT Splines are fin to groove anti rotational design Consist of six external components called tines which protrude 1mm from implant and are matched to a female embedded in a abutment base www.indiandentalacademy.com
  19. 19. MORSE TAPER ATTACHMENT -Consist of 1 piece abutment post with 5 degree taper -resist rotation and even removal -also referred to as cold welded design www.indiandentalacademy.com
  20. 20. Guidelines for abutment selection • Depth of soft tissue  vertical height from implant head to the gingival margin  Measured with periodontal measuring probe  labial margin of abutment is atleast 1mm subgingival  Marked discrepancy between gingival heights around the margin – prepable abutment is indicated  Diameter close to that of cervical margin of tooth www.indiandentalacademy.com
  21. 21. • Emergence profile  Need atleast 3mm of vertical space from implant head to gingival margin  Allows gradual transition from implant head www.indiandentalacademy.com
  22. 22. • Orientation  Ideally implant is placed close to the long axis of missing tooth (thro incisal tip or just palatally)  Small degree of labial angulation – easily accomodated with standared abutments  If more labial angulation needed – use of standard abutment leads to 1. Excessively contoured labial surface 2. Porcelain surface too thin to mask metal structure  Better results achieved with prepable / fully customised abutment www.indiandentalacademy.com
  23. 23. • Interocclusal space     Space from implant head to opposing tooth Vertical space of 6-7 mm – standard abutment 5mm of space – prepable abutment Less than 5mm of space – vertical dimension of occlusion increased, deeper implant placement • Special esthetic requirements  Angulated abutments – for esthetics and biomechanical reasons www.indiandentalacademy.com
  24. 24. ABUTMENT RETENTION The retention of a fixed cemented restoration – resist removal of the retainer along the path of insertion Resistance – opposes movement of the abutment under occlusal loads and prevents removal of restoration by forces in apical and oblique direction www.indiandentalacademy.com
  25. 25. The tenets of retention and resistance include • Abutment taper – Retention of a crown decreases as the taper is increased from 6-25 degrees – Ideal taper was recommended to be within 2-5 degrees of parallelism of path of insertion – Parallelism of axial walls has been recognized to be single most factor for retention – Eames et al – found that clinically acceptable preparations present a taper of 20 degrees www.indiandentalacademy.com
  26. 26. Abutment surface area  There is linear increase in retention as the diameter increase for preparation with identical height  Diameter of an implant abutment for cement retention is often less than 5mm which is comparable to prepared lateral incisor – so decrease in surface area results in poorer retention than most natural abutment www.indiandentalacademy.com
  27. 27. Abutment height  A tall preparation offers greater retention than a short abutment  Increase in height – increases surface area , increased resistance to lateral forces  Height of the abutment must be greater than the arc formed by the crown rotating about a fulcrum at the margin of the opposite side of the restoration www.indiandentalacademy.com
  28. 28.  Abutment surface roughness  Surface roughness increases the retention of a restoration by creating micro retentive irregularities into which the luting agent projects  Surface roughness retention is dependent upon the type of burs along with the type and thickness of luting agents  Large size cross cut fissure bur – reduce height and gross reduction of metal abutment post  Coarse diamond – increase amount and depth of microscopic scratches on the surface to more than 40 micro meter  Internal aspect of the casting should be air abraded with 50 micro meter alumina to enhance retention by 64% www.indiandentalacademy.com
  29. 29. STERI OSS ABUTMENT Central retaining screw which fixes abutment to implant after engaging the external hex PARAGON ABUTMENT - Angled abutment system - Presented with three components - the collar with hexagonal base , external hex -octagonal. - offers 3 angled abutment position ( 15,20,25 degrees ) . so entire system offer 24 possible combination of angle and direction www.indiandentalacademy.com
  30. 30. CERAONE ABUTMENT • • • • • • • • • Components : Implant coping Abutment replica and healing cap Gold abutment screw Abutment Titanium fixture Cut down coping Aluminium oxide ceramic core Abutment available in 5 heights – 1,2,3,4,5 mm www.indiandentalacademy.com
  31. 31. - Designed for anterior maxillary single tooth cementable porcelain restorations - Consists of implants with non rotating interface with abutment and gold alloy abutment screw - Ceramic cap –available in cylindrical form for posterior arch and tapered form for anterior arch that fits over ceraone abutment - Cap- made up of densely sintered semi translucent aluminium oxide which is designed to be fused with porcelain and cemented permanently to abutment www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. - In posterior areas- ceraone abutment is used with ceramometal coping - Since esthetics may not be critical in posterior areas, plastic wax up coping is used to fabricate ceramometal coping with or without access channel to which porcelain is fused • To facilitate during troubleshooting , a lingual removal button is designed • A narrow occlusal access channel can also be fabricated in gold to facilitate reentry www.indiandentalacademy.com
  34. 34. • ESTHETICONE ABUTMENT - Noble biocare abutment - hex shaped,tapered sides - features a female hex which interface with implant male hex head and is secured by a titanium abutment screw www.indiandentalacademy.com
  35. 35. - indicated in multiple implant situation without causing esthetic compromise with the metal display - designed to allow esthetic veneering material to be placed subgingivally - abutment made of surgical grade titanium and available in 1,2,3 mm collars www.indiandentalacademy.com
  36. 36. • CERADAPT ABUTMENT - All ceramic alternative to metal abutments - Pre machined precision milled abutment made to fit the implant hex - made up of densely sintered 99.8% pure aluminium oxide which are pressed into desired shape and subjected to sintering temperature of 2050 degrees Celsius - pore free strong wear resistant stable bio ceramic material www.indiandentalacademy.com
  37. 37. - Andersson and Oden showed flexural strength of 690 MPA and demonstrated that the abutment can withstand tremendous loads without fracturing - it is a non metallic , non corrosive , bio compatible.soft tissue response is excellent - tooth coloured and light diffusion property – more natural and esthetic implant crown - used for implant supported single and multiple tooth restoration in the anterior canine and premolar regions - can be either screw or cement retained www.indiandentalacademy.com
  38. 38. • OCTA ABUTMENT - Low profile component used with ITI implants - Used in esthetically sensitive maxillary anterior region - Pre fabricated gold caps are available for attachment to removable super structures - Internal octagonal design – resistance against crown rotations www.indiandentalacademy.com
  39. 39. • UCLA ABUTMENT - Improved esthetics - Gold alloy abutment screw retention increases the preloading force - Abutment can be custom reangulated - All abutment have a non rotating configuration - Improved emergence profile www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. - Each restoration has a tapered interface similar to that of a standard FPD restoration - Multiple butt joint prosthesis interface avoided - Lingual screw retention for fixed retrievability - practical and esthetic www.indiandentalacademy.com
  42. 42. • CUSTOM REANGULATED UCLA ABUTMENT - Eliminates need for prefabricated angled abutment Simplifies construction Results in better esthetics When implants are not parallel , parallelism can be obtained - Abutment fabricated to interface directly with the implant using a pre machined gold palladium cylinder www.indiandentalacademy.com
  43. 43. - Secured with titanium abutment screw - Pre machined internal hex interfaces with implant male hex provides maximum resistance to lateral forces and screw loosening - Lingual surface of abutment is tapped to receive a gold screw – fixed retrievabiltiy www.indiandentalacademy.com
  44. 44. • NOBLE PHARMA SINGLE TOOTH ABUTMENT - Titanium abutment cylinder connects to the implant fixtures - Available in various sizes depending upon the thickness of peri implant tissues ( 1-5 mm ) - Restorations are designed to be cemented - Two piece elements (crown and abutment cylinder) is connected to implant fixture with a titanium screw www.indiandentalacademy.com
  45. 45. • MIRUS CONE ABUTMENT - Used for multiple implant screw retained restorations - Available with 1,2,3 mm collars - Soft tissue thickness determines appropriate collar height - Designed for situations where inter occlusal distance is minimal - gold alloy screws with hex head retains abutment with implant www.indiandentalacademy.com
  46. 46. • BRANEMARK SYSTEM ANGULATED ABUTMENT • - Developed by Noble pharma Designed to adjust access hole position,prosthetic screw angulation Improved esthetics 30 degrees, 12 sided internally designed component which can be in 12 different positions components: Implant Angulated abutment Abutment screw Gold cylinder Prosthetic screw Brass replica Healing abutment www.indiandentalacademy.com
  47. 47. ASTRA ABUTMENT • Presented with the option of 20 or 40 degree tapered top • Used for fixed bridges / over dentures www.indiandentalacademy.com
  48. 48. Abutment try-in kit • Provide replicas of abutment types that can greatly assist abutment selection • Tried intraorally or on a cast • Made up of aluminium – not damage the implant • Color coded for easy recognition • Used for better screw access position ,marginal height and emergence www.indiandentalacademy.com
  49. 49. • TREATMENT PLAN • Single tooth implant abutment • • • • Two piece abutment with straight emergence profile Two piece abutment wider than implant body Two piece anatomic or bioesthetic abutment Two piece custom abutment www.indiandentalacademy.com
  50. 50. • Fixed / fixed detachable prosthesis  UCLA Abutments  Similar custom cast abutments • Hybrid bridge fixed detachable prosthesis • Fixed bridge made of denture teeth processed to cast metal barlike frame work. • Prosthesis must be screw retained and is usually used in arches that are completely edentulous • standard , conical ,Tapered shouldered ,flat topped abutments • The abutment acts as platform on which the hybrid bridge framework seats www.indiandentalacademy.com
  51. 51. • Implant supported over dentures • Shouldered abutment that accepts a screw retained bar / super structure attachments • O ring , zest attachments , paragon attachments www.indiandentalacademy.com
  52. 52. JOURNAL REVIEW www.indiandentalacademy.com
  53. 53. Removal of a fractured implant abutment screw ( Ibrahim , JPD,June 2004) Implant repair kit : • Center bit • 1.3mm twist drill • 1.9 mm twist drill • Conical instrument to retrieve the fragment • Manual tapping instrument www.indiandentalacademy.com
  54. 54. A locating splint for placing implant abutment (Edmond , JPD , Jan 2004) • After placement of abutment , a definite impression is required because slight rotation of abutment is observed • This article presents a technique to avoid this. www.indiandentalacademy.com
  55. 55. Computer generated Procera abutment • Custom abutment-designed by a computer and machined to exact specification • Head of implant impression made and working model is placed in the scanner • Readings of implant angulation and position are taken • Using cad-cam software,ideal abutment is generated • Advantages     Precise fit Ideal emergence profile Improved esthetics Proper restoration contours www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. Bibliography • • • • • • Atlas of oral implantology – A.Norman Cranin Contemporary implant dentistry – Carl.E.misch Implants in clinical dentistry – Richard.M.Palmer Implant prosthodontics – Stevens Friedrickson The Branemark implant system – John Beumer Dental implants fundamental and advanced lab technology – Winkelman • Atlas of tooth and implant supported prosthodontics – Lawrence.A.Weinberg www.indiandentalacademy.com
  58. 58. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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