0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

Treatment guidelines

Abutment materials

Key points

An abutment is a component that is intermediate between the implant and the restoration and it is usually screw-retained to the implant
The abutment provides the retention, support, stability and optimal position necessary for the definitive restoration
Titanium and zirconia are the most commonly used materials for abutment fabrication
Abutments can be prefabricated by the manufacturer, or custom CAD/CAM produced

Abutment types and selection - general considerations

Implant-based prostheses can be cement-retained, screw-retained or a combination of both (Fig 1). By definition, an abutment is a component that is intermediate between the implant and the restoration and it is usually screw-retained to the implant. The abutment provides the retention, support, stability and optimal position necessary for the definitive restoration. There are other available options (locking taper, one-piece implants) where the abutment is part of the implant itself, however they are less popular as these concepts are less flexible regarding prosthetic restoration options.

Abutment materials

The abutment is generally being custom-designed/fabricated in a dental laboratory or prefabricated by the implant manufacturer.

The most popular abutment material options are:

Titanium
Zirconia
Precious alloy cast (UCLA abutment, telescopic crowns)
Resin
PEEK (Polyetherketone)

Implant abutments are usually fabricated from surgical grade titanium alloys due to the well-documented biocompatibility and mechanical properties. However, although they are very stable from a biomechanical point of view, titanium abutments present limitations in esthetically relevant areas. In the anterior zone, when visible during function, the harmony in terms of color and form between the restoration-implant complex and the gingiva plays a major role and in that respect, zirconia is recommended as an alternative material to titanium abutments. Zirconia abutments are available as full zirconia or - depending on shape, manufacturer and strength- with a Titanium core. An alternative to the version with the metal core is to custom-design and mill the zirconia abutment chairside and bond it onto the metal adapter.

Individually waxed and cast UCLA-type abutments have lost popularity and have been replaced by CAD/CAM-milled or prefabricated options. However the casting technique is an option for the design and fabrication of overdentures retained by telescopic crowns.

Resin and PEEK-type abutments are usually only indicated for temporary use and provisional restorations.

Fig 2: Procera® Esthetic Abutment (Zirconia), Esthetic Abutment (Titanium).Pre-fabricated, customizable titanium and zirconia abutments for single- and multi-unit, cement-retained restorations. These abutments offer various margin and angulation designs to minimize chairside adjustments.

Fig 3: NobelProcera™ Abutment for cement-retained solutions.Materials: Zirconia & Titanium.Indication: for single- and multi-unit restorations.Contraindication: large-span bridges (excess cement control).Platforms: all Nobel Biocare and other major implant platforms.

Fig 4: Multi-unit abutment.This abutment is used for multi-unit, screw-retained restorations. It offers a simplified prosthetic access at tissue level and is indicated for edentulous and partially edentulous situations. Multi-unit abutments can be straight (left) or angulated (right) to compensate for the angulation of tilted implants.

Clinical topics

Treatment guidelines

Screw-retained restorations, overview

Screw-retained restorations are designed to be screwed either directly onto the implant or onto a screw-retained abutment positioned on the implant (Multi-unit Abutment). Screw-retained restorations represent a secure and easy way to...

Treatment guidelines

Cement-retained restorations, overview

Cement-retained restorations are a traditional design to attach a restoration (crown, bridge) to an implant-retained abutment, similar to cementing a crown or bridge restoration on a natural tooth. With the traditional, relatively...

Additional resources

Videos

Stefan Holst: Prosthetic considerations for edentulous patients

The lecture reviews decision criteria for material selection and design options in edentulous restorations. From a clinical and patient expectation standpoint, removable and fixed restorations provide comparable long-term outcome. Removable restorations can offer advantages, such...

Videos

Roland Glauser: Fixed or removable restorations for the edentulous patient

The lecture gives insight in the decision criteria for prosthetic restoration planning in edentulous situations. Dr Glauser discusses extraoral examination parameters and the different levels of decision making such as evaluation of lip support, lip line and transition zone...

Videos

Chandur Wadhwani: Implants, cement and peri-implantitis - science and the missing link

Cementation procedures and materials have been reported to cause complications in implant prosthetics, mainly inflammation around the implant due to cement material excess. Cementation procedures are a complex system, not all the dimensions of which seem to be fully understood and...

Questions

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Anonymous

16.10.2020 | 00:45

is there any evidence where they have compared all materials used to make abutments and compared their success rates ?

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is there any evidence where they have compared all materials used to make abutments and compared their success rates ?

Abutment materials

Abutment types and selection - general considerations

Clinical topics

Related articles

Treatment guidelines

Screw-retained restorations, overview

Treatment guidelines

Cement-retained restorations, overview

Additional resources

Videos

Stefan Holst: Prosthetic considerations for edentulous patients

Videos

Roland Glauser: Fixed or removable restorations for the edentulous patient

Videos

Chandur Wadhwani: Implants, cement and peri-implantitis - science and the missing link

Scientific References

Questions

is there any evidence where they have compared all materials used to make abutments and compared their success rates ?