Most patients after dental implant placement could have questions like: how many components are there?
what is an abutment? how does the crown fit into it all? what kind of abutment and crown will be placed?
And the
question: Do you really need to worry about all of these?
The answer is
ABSOLUTELY YES.
The fact is not all abutments and crowns are created equal. Typically,
following the placement of a dental implant, patients must return to their
restorative dentist to have the final abutment and crown made. The type and
shape of the abutment and crown is critical in achieving longevity and success
with the aesthetic and functional results you expect. But far too often, poor
abutment and crown designs lead to compromised results and unhappy patients.
For best results, make sure your restorative dentist uses a customized abutment
for your dental implant. Let’s first review some basics:
A dental implant-supported tooth is made of three parts:
1. The dental implant: This is the foundation which supports the overlying abutment and crown.
2. The abutment: The abutment is attached to the implant and supports the overlying crown.
3. The crown: This is the actual tooth that you see.
There are two types of abutments: Custom and stock (pre-fabricated.)
Custom abutments are made by a dental laboratory. The restorative dentist captures the position of the implant and the shape of the surrounding gum tissue by taking an impression. The laboratory then fabricates an abutment that resembles the emergence and shape of a natural tooth. The custom abutment will fit perfectly on the implant and supports the gum tissue similar to a natural tooth.
Stock abutments are manufactured by dental implant companies. Although such pre-fabricated abutments fit well into the implant, they rarely offer proper shape and form. The results are often over-contoured or under-contoured abutments that do not shape the gum tissue properly and create a very unnatural appearance of the crown. Patients often complain of poor aesthetics, ‘dark’ margins, and difficulty with cleaning them.
What should you do as a patient?
1. Ask your dentist what type of abutment is planned. Make sure that they give you a custom abutment. This is simply done by taking an impression of your dental implant and sending it to a laboratory to be processed. A low cost dental implant deal may be a good indication that stock abutments are being used instead of custom abutments, as pre-fabricated stock abutments are less costly to the dentist.
2. Ask what type of crown they are making. Depending on the area of the mouth and location of the implant, you have choices of all ceramic crowns vs. zirconia crowns. In the smile zone, all ceramic abutments and crowns are more commonly used, while in back of the mouth, titanium abutments with full zirconia crowns generally work quite well.
Dentists at S-PLANT say : Especially In the esthetic zone, the use of custom abutments is an absolute must. There is no better way to create acceptable subgingival contour that matches that of a natural tooth. In addition you cannot adequately control the position of the margin with a stock abutment, which place you at higher risk of trapping cement subgingivally. This a silent but potentially catastrophic issue because once it is there it is often very difficult to remove it and may times the clinician may not be aware that this has occurred until many months after the restoration has been placed.”
In conclusion, custom abutments may cost more, but they can offer better tissue management and esthetics.
