Custom vs. Prefabricated Abutments

Dec 5

A question often asked by some clinicians when planning for dental implants, is whether to use a prefabricated abutment or custom abutments. Some clinicians use prefabricated abutments to lower cost and eliminate the time required for custom impression.

The fact is prefabricated abutments are very limited in their use and are inappropriate for most sites. This is because they do not provide the proper support, emergence, profile, and contour for the restoration. As the result, patients often complain of unaesthetic crowns and problems with frequent food impaction. It is recommended to always use custom abutments which consistently provide better results.

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.

In addition to selecting a custom abutment, restorative dentist should pay close attention to clinical requirements and appropriate contours of the restoration to achieve the desired result. They must precisely assess the size of the space, occlusal table, relationship to opposing arch, soft tissue thickness and position of the implant, and guide the laboratory technician with fabricating the right custom abutment and restoration. This can be communicated with study models, photos, specific instructions on contour requirements, and dimensions of the restoration.

To achieve highly aesthetic, functional, and hygienic dental implant restorations, the following are required:

Adequate bone width and height
Adequate soft tissue thickness
Proper implant width
Precision implant position, angle, and depth
An abutment that follows natural tooth anatomy at the gingival interface
A crown that has proper contour and marginal integrity following the emergency of the abutment
Proper anatomy of the abutment and crown at the embrasure space to support the papilla