Customized Healing Abutment Research Articles

Clinical Advantages of Immediate Posterior Implants With Custom Healing Abutments: Up to 8-Year Follow-Up of 115 Cases

Proper management of the soft tissues around dental implants is crucial to their long-term function and esthetics. The purpose of this article is to report the survival rate of immediate posterior implants when using an immediate chair-side technique for custom healing abutments. The investigator implemented a retrospective case series analysis of a sample of 115 consecutive patients with 1 posterior dental implant placed between February 1, 2012 and December 9, 2014, in the author's private practice who underwent the previously published technique for immediate custom chair-side healing abutment fabrication. In this descriptive analysis, the primary outcome variable was implant survival. Other variables included patient gender and age. Of the 115 patients in this cohort, 66 were female and 49 were male, with a mean age of 58 years, with 73% of the sites being first molars and 27% secondmolars. This study sample had a 98.26% overall implant survival rate with 3 implant failures. Median follow-up time was 1year with identical 1-year and 5-year survival rates. Follow-up at up to 8years demonstrated a 98.26% overall survival rate with 100% survival in the maxilla and 96.08% in the mandible. This case series demonstrates that the Anatomic Harmony Abutment technique, by applying principles of flapless posterior immediate implant surgery with immediate custom healing abutment placement, can lead to highly successful implant outcomes.

Immediate implant placement using customized healing abutments as a method of hard and soft tissue preservation. A review article

Immediate implant placement using customized healing abutments as a method of hard and soft tissue preservation. A review article

Preserving the tissue profile with immediate implant placement and immediate provisionalization technique

Background: Single-tooth replacement in the esthetic zone with a dental implant remains a challenge for clinicians. One challenge is the difficulty of creating a natural tissue profile in the cervical of the implant restoration. In a healed edentulous ridge, multiple surgeries along with hard- and soft-tissue augmentation will be required to gain sufficient tissue volume, thus significantly increasing the patient morbidity. Immediate implant placement, combined with a customized healing abutment, can potentially overcome these difficulties. Case Report: This case report describes the treatment of a patient with a subgingival fracture of the upper central incisor with an implant placement immediately after tooth extraction, xenograft gap filling, and nonfunctional provisional restoration to seal the extraction socket. The incisor had previously undergone root canal treatment and had been restored using a fiber post and ceramic crown. Conclusions: The use of the immediate implant placement with a nonfunctional provisional restoration (immediate implant placement and immediate provisionalization) technique preserves the tissue profile and volume during the implant healing period. This provides the clinician with a natural soft-tissue profile for implant restoration, without the need for an additional surgery.

Digitally Fabricated Provisional Implant Restorations Prior to Implant Placement: A Clinical Case Series.

To review the factors that affect the ability to deliver a CAD/CAM implant-supported provisional restoration designed from a virtually planned implant position prior to surgical placement with static computer-assisted implant surgery (sCAIS). Data were collected on patients treated with single-tooth implant treatment in which CBCT was combined with intraoral scans and imported into a virtual implant planning software. A synchronization tool established the connection between the planning software and the CAD software, where a digital diagnostic tooth arrangement was performed to create the ideal tooth dimensions and mucosal architecture. The virtual implant planning was finalized, and the implant position was transferred to the CAD software, where a restoration was designed and fabricated. The sCAIS was performed, and the prefabricated custom restorations were delivered on the day of the surgery or following healing if delayed loading or submerged healing was required. Descriptive statistics and statistical comparison with two-proportion z test were performed. A total of 23 patients with 28 single-implant sites met the inclusion criteria and were included in the study. Nineteen customized healing abutments and 10 provisional crowns were designed and fabricated for a total of 29 restorations. Of the restorations, 23 were successfully delivered on the day of the surgical intervention. No statistical significance was found among the different variables compared. Custom prefabricated CAD/CAM restorations based on a virtually planned implant position can be successfully designed, fabricated, and delivered when used in combination with sCAIS.

A new method of conclusively creating and transferring the emergence profile on single tooth immediate implant restorations: the E-merge protocol.

The purpose of this article is to propose a new protocol for the accurate transfer of the peri-implant soft tissue emergence profile (EP) using a customized healing abutment or a provisional restoration whose shape is integrated into prosthetic design software. The EP of the future restoration is created extraorally with an ideally shaped customized healing abutment or a provisional crown. Before insertion, the latter is screwed into a repositionable analog placed on a specially designed device and scanned with an intraoral scanner (IOS). This repositionable analog (Straumann RB Repositionable Implant Analog, Art. no. 065.0023), whose original purpose is to keep the correct orientation of the implant platform when placed in a printed model, is already available on the market. It is an exact replica of the implant with a corresponding external index. When scanned, it allows the digital transfer of the exact implant position and index. After healing, a full-mouth impression is made with an IOS without removing the customized healing abutment or provisional restoration. The STL files issued from both impressions are merged to produce a digital model used to design the final restoration, which can be inserted at the next appointment. The technique described is simple, predictable, and precise. It does not require a traditional implant level impression or the use of a digital accessory such as a scanbody to transfer the 3D implant position and the peri-implant gingival contour.

Effect of customized healing abutments on the peri-implant linear and volumetric tissue changes at maxillary immediate implant sites: A 1-year prospective randomized clinical trial.

Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices (CM) seems to reduce the amount of resorption at peri-implant areas. Recently, customized healing abutments (CA) appeared as another solution in order to seal the socket and preserve the original soft tissue contour. To evaluate peri-implant tissues dimensional changes after using customized healing abutments compared with the use of xenogeneic collagen matrices as socket sealing options in flapless maxillary immediate implant placement. The present study was designed as a prospective, randomized, controlled clinical trial. Patients were allocated into two groups depending on the socket sealing option: in the CM group a collagen matrix was used and in the CA group a customized abutment. Digital impressions were taken prior to extraction, 1, 4, and 12months after implant insertion and the digital files allowed to evaluate linear buccal changes (MBC) and the buccal volumetric variation (BVv) between the different time points at peri-implant tissue areas. Additionally, mucosa variation was computed assessing the papilla presence and the midfacial mucosa height. Statistical significance was set at 0.05. Twenty-eight patients were observed during a 12-month period. Significant differences between mean values of BVv at the first month were observed at the CM and CA group (-9.75 ± 6.65% and -4.76 ± 5.29%, respectively) (p=0.043). At the 1-year follow-up, no significant differences were found in terms of BVv between the two groups, although the thin bone phenotype (≤1 mm) significantly influenced the volumetric variations that occurred in each group. No significant differences were noticed in midfacial mucosa and papillae alteration between groups, after 1 year of treatment. Both treatment options are predictable solutions for socket sealing in IIP, although a higher volumetric variation can be expected in the presence of thin bone phenotypes.

Sealing Socket Abutments (SSAs) in Molar Immediate Implants with a Digitalized CAD/CAM Protocol: Soft Tissue Contour Changes and Radiographic Outcomes After 2 Years

Immediate implant placement in molar sites has the potential to improve the patient experience by reducing the number of appointments and the overall treatment time. However, primary closure remains a technical challenge. The present prospective case series evaluated the soft tissue contours and the radiographic bone levels of 17 patients who received immediate implants in molar sites and a digitally customized CAD/CAM sealing socket abutment. At the 2-year follow-up, the mean buccal tissue contours at the most coronal portion were reduced horizontally by an average of 1 mm at 1, 2, 3, and 4 mm below the gingival margin. A mean 0.53-mm apical migration of the gingival margin was seen, and the mean interproximal bone level at the 2-year follow-up was 0.89 mm. The use of CAD/CAM-generated customized healing abutments in immediate molar sites yielded minimal hard and soft tissue changes at the 2-year follow-up.

PEEK Biomaterial Use for Chairside CAD/CAM Dental Restorations: Bridging the Gap to Future

Background: Advanced computer-aided design and computer-aided manufacturing (CAD-CAM) technology led to the introduction of an increasing number of machinable materials suitable for dental prostheses. One of these materials is polyetheretherketone (PEEK), a high performance polymer recently used in dentistry with favorable physical, mechanical and chemical properties. Purpose: The aim of this study was to review the current published literature on the use of PEEK for the fabrication of dental prostheses with CAD-CAM techniques. Methods: Electronic database searches were performed using the terms “PEEK”, “CAD-CAM”, “dental”, “dentistry” to identify studies related to the use of PEEK for the fabrication of CAD-CAM prostheses. Results: A great number of in vitro studies are available in the current literature pointing out the noticeable properties of PEEK. The use of PEEK has been recommended for a wide range of CAD-CAM fabricated fixed and removable dental prostheses, occlusal splints, intra-radicular posts, implant abutments, customized healing abutments, space maintainers for pediatric dentistry, orthodontic appliances and provisional restorations. However, only a few clinical studies were identified. Conclusions: PEEK could be considered as a viable alternative for CAD-CAM dental appliances to well-established dental materials. Due to the scarcity of clinical data, clinical trials are needed to assess the longterm performance of PEEK prostheses.

Vestibular Socket Therapy: A Novel Approach for Implant Placement in Defective Fresh Extraction Sockets With or Without Active Socket Infection (One-Arm Cohort Study).

This study aimed to assess the radiographic, esthetic, and periodontal outcomes after 1 year of implant placement in compromised fresh extraction sockets in the esthetic zone using vestibular socket therapy. Implants were placed in type 2 sockets using vestibular socket therapy, which includes immediate implant placement, vestibular incision, and cortical bone shield stabilization, along with filling the socket gap with particulate bone graft, then sealing the socket orifice with a customized healing abutment in one visit. A 6-day protocol of antimicrobial therapy for treating sockets with active infection was also described. Assessment included measuring bone height and labial plate thickness at three levels at baseline and after 1 year, in addition to pink esthetic score and periodontal parameters (modified sulcus Bleeding Index and peri-implant probing depth) after 1 year. SPSS was used to calculate descriptive statistics of outcome measures. All 16 implants used in the study showed success. There was a significant increase of bone height and bone thickness at the middle and crestal thirds (mean [SD] gain = 6.08 [3.07], 1.65 [0.91], and 1.18 [1.51]). The mean (SD) pink esthetic score was 12.63 (1.71), the mean (SD) modified sulcus Bleeding Index was 1.19 (0.40), and the mean (SD) peri-implant probing depth was 1.97 (0.46) mm. Vestibular socket therapy was successfully used in compromised sockets with optimum radiographic, esthetic, and periodontal outcomes in addition to minimizing treatment time and number of surgical interventions. The 6-day protocol was able to eliminate infection and prepare sockets for implant placement.

Comparison of residual cement between CAD/CAM customized abutments and stock abutments via digital measurement in vitro

OBJECTIVE To compare the residual cement between computer aided design/computer aided manufacturing customized abutments (CCA) and stock abutments (SA), and to evaluate the feasibility of digital measurement for residual cement volume by three-dimensional scanning. METHODS Twenty master models needed in this study were all taken from one 47-year-old patient with arrested periodontitis, who had already had an implant placed at his right upper central incisor site in the Department of Periodonto-logy, Peking University School and Hospital of Stomatology. After 4 weeks of soft tissue conditioning by means of customized healing abutment, the height of peri-implant soft tissue was measured, from the implant platform to mucosal margin, as 5 mm. Using customized impression coping, the impression was taken and twenty models were fabricated and allocated to 4 groups according to the type of abutments: CCA1 (5 mm transmucosal height CCA, with margin at tissue level), CCA2 (4 mm transmucosal height CCA, with 1 mm submucosal margin), SA1 (3 mm transmucosal height SA, with 2 mm submucosal margin) and SA2 (1 mm transmucosal height SA, with 4 mm submucosal margin). Crowns were cemented to the abutments, which were seated on the working models. Excess cement was removed by a prosthodontic specialist. Thereafter, the volume of residual cement was evaluated by using three-dimensional scanning technique. The area proportion of residual cement was calculated on photographs taken by a single lens reflex camera. The weight of residual cement was weighed by an analytical balance. And the correlation of residual cement volume data with residual cement area proportion or weight of residual cement acquired by traditional methods was analyzed. RESULTS Residual cement was observed on all the experiment samples. The residual cement volume of CCA was significantly less than that of SA [(0.635 3±0.535 4) mm3vs. (2.293 8±0.943 8) mm3, P 0.75, P < 0.001). CONCLUSION These in vitro results suggest that CCA minimized the residual cement more effectively than SA. The method to digitally evaluate the residual cement volume is feasible, but its validity and reliability need to be further studied.

Fabrication of a CAD-CAM custom healing abutment guided by a conventional dental radiograph for delayed loaded dental implants: A dental technique

This article describes a technique for fabricating a custom anatomic healing abutment for delayed loaded implants by using the computer-aided design and computer-aided manufacturing (CAD-CAM) technology from a polymethyl methacrylate (PMMA) blank. The dimensions of the custom healing abutment are measured from a conventional dental radiograph and diagnostic casts. The healing abutment is used in the second surgical stage to guide soft tissue healing. The resulting soft tissue contour guides the design of the mucosal part of the custom implant abutment.

Volumetric analysis on the effect of a customized healing abutment at maxillary immediate implant sites: a prospective randomized clinical trial

Volumetric analysis on the effect of a customized healing abutment at maxillary immediate implant sites: a prospective randomized clinical trial

Evaluation of Horizontal and Vertical Buccal Ridge Dimensional Changes After Immediate Implant Placement and Immediate Temporization With and Without Bone Augmentation Procedures: Short-Term, 1-Year Results. A Randomized Controlled Clinical Trial.

This prospective randomized controlled clinical trial aimed to compare changes in the horizontal and vertical soft tissue and the alveolar ridge dimension over the course of 12 months following immediate implant placement and temporization with or without simultaneous augmentation with a deproteinized bovine bone mineral with 10% collagen (DBBM-C). Thirty-two patients with a hopeless maxillary anterior tooth and fully intact sockets received an immediate implant and provisional or custom healing abutment after a flapless extraction. Patients were randomized to a control group (n = 16), which received no graft, or to a test group (n = 16), which received DBBM-C grafts. Horizontal and vertical soft tissue changes as well as soft tissue thickness were compared digitally between groups on casts obtained from impressions made at baseline and 3, 6, and 12 months. The test group showed less horizontal dimensional change than the control group; however, the change between the two groups was not statistically significant. Vertical dimensional soft tissue changes from baseline to 12 months showed a statistically significant difference at the distal papilla, favoring the test group. No statistically significant difference was observed for vertical changes between both groups at mesial papillae and midbuccal soft tissue; however, the test group showed lower values overall. No statistically significant differences in soft tissue thickness between groups were detected. Immediate implant placement and temporization with and without adding DBBM-C demonstrate favorable clinical outcomes regarding horizontal and vertical soft tissue changes. Both groups showed loss of tissue volume. Adding DBBM-C in the gap of immediately placed implants slightly lowered the change in tissue parameters, which was not statistically significant, for the first 12 months after implant placement.

Customized healing abutment: An alternative technique for maintain peri-implant soft tissue and create implant crown emergence profile

The immediate load procedures in immediate implants have become routine in dental offices because of high esthetics demand by clients. Nevertheless, in some cases, it is not possible to perform immediate load procedures. The purpose of this article was describing the technique for creating a customized healing abutment to preserve the contours of peri-implant soft tissues and maximize peri-implant esthetics in immediate implants when it is not possible to place provisional crowns directly onto the implant. This technique is simple and easily performed and is an interesting alternative treatment for maintaining the stability of the peri-implant tissues while the osseointegration time.

Comparison of Peri-implant Soft Tissue Color with the Use of Pink-Neck vs Gray Implants and Abutments Based on Soft Tissue Thickness: A 6-Month Follow-up Study.

To compare the optical effects of an immediately placed anodized pink-neck implant and abutment vs a conventional gray implant and abutment in relation to soft tissue thickness 6 months after the restoration was completed. Forty patients with a hopeless maxillary anterior tooth received an immediate implant and an immediate provisional or custom healing abutment after flapless extraction. Participants were randomized to receive either a conventional titanium implant (control) or a pink-neck implant (test). All patients then received two identical CAD/CAM titanium abutments (one conventional gray, delivered first, and one anodized to appear pink, delivered 3 weeks after) and a zirconia crown. A spectrophotometer was used to record the color of the peri-implant mucosa and gingiva 3 weeks after delivery of each abutment and 6 months after the final restoration was delivered. The color difference between the two sites was calculated (ΔL*, Δa*, Δb*), and correlations with soft tissue thickness, change in ridge dimension, and implant position were assessed. Irrespective of the randomization group, changing the abutments from gray to pink showed a change in color between the peri-implant mucosa and the natural gingiva. Patients with a thin gingival biotype showed a statistically significant color change (P = .00089) in the a* axis, meaning that the gingiva appeared more pink (Δa*). No significant correlation between the soft tissue color and buccolingual collapse, vertical recession, or implant position was observed in either group. The difference in color observed between the peri-implant mucosa and the gingiva was considerable in all groups. Anodized pink implants and abutments could reduce the difference in the red aspect (Δa*) of the peri-implant mucosa compared to the adjacent gingiva in patients with a thin biotype.

Implante imediato sem estabilidade primária – uma abordagem em área estética

Oral rehabilitation with the use of dental implants has made significant progress in recent years, especially for the development of more predictable and bold materials and protocols.Thus, the immediate rehabilitation of a dental absence, mainly in the aesthetic area, becomes a preferable alternative to late approaches. The reason for this approach would be to preserve the original bone and gingival architecture by optimizing the aesthetic result of the treatment, even in cases where excellent primary stability is not obtained for immediate implant loading. In view of this context, the objective of this article is to report a clinical case of an upper central incisor rehabilitation with immediate implant, followed by bone graft, customized healing abutment, and temporary restoration for aesthetic purposes. It was concluded that the immediate implant installation after tooth extraction may be associated with the reduction of bone resorption of the dental alveolus, the reduction of the treatment time, and the immediate aesthetic result, in addition to providing the patient with greater comfort and convenience, eliminating a second surgical procedure for implant installation, even when a primary implant stability is not achieved.

Standard vs customized healing abutments with simultaneous bone grafting for tissue changes around immediate implants. 1-year outcomes from a randomized clinical trial.

Immediate implants have shown risks of esthetic complications. The hypothesis was that a customized healing abutment could improve the peri-implant tissue healing. To evaluate and compare the soft and hard tissue healing around immediate implants that received bone grafting and a customized vs a standard healing abutment. Patients, who required tooth extraction and who received an immediate implant (with an alloplastic graft material) were randomly assigned to a customized or a standard healing abutment group. Clinical and radiographic examinations were taken at baseline, at 4 and 12 months. Twenty-five patients out of 61 were excluded from the study because unsuitable for immediate implantation. In total, 36 patients were randomized in the two groups. There were 17 females and 19 males (age range 23-77). No prosthetic or implant failure was registered during the study period. The Papilla Index was significantly higher in the customized than in the standard group at 4 and 12 months (P = .0002). The bone loss at mesial sites was significantly higher in the control than in the test group (P = .0014). The customized healing abutment group showed the most favorable outcomes (in terms of PI and MBL) in case of immediate implant that received a peri-implant bone grafting procedure.

Copy milling to duplicate the emergence profile for implant-supported restorations

This technique article describes the duplication of a definitive implant-supported computer-aided design and computer-aided manufacture (CAD-CAM) crown with soft-tissue modification on a misplaced implant. Gingival contours were ideally shaped in the stone die, and a custom healing abutment was designed. After scanning the modified surface, images were correlated with the initial intraoral digital scan, and the definitive restoration was designed, milled, and delivered with an ideal soft-tissue emergence profile.

Peri-Implant Soft Tissue Conditioning by Means of Customized Healing Abutment: A Randomized Controlled Clinical Trial.

Introduction: An optimal aesthetic implant restoration is a combination of a visually pleasing prosthesis and adequate surrounding peri-implant soft tissue architecture. This study describes a novel workflow for one-step formation of the supra-implant emergence profile. Materials and Methods: Two randomized groups were selected. Ten control group participants received standard healing screws at the surgical stage. Ten individualized healing abutments were Computer aided Design/Computer aided Manufacturing (CAD/CAM)-fabricated out of polyether ether ketone (PEEK) restoration material in a fully digital workflow and seated at the surgical stage in the test group. The modified healing abutment shape was extracted from a virtual library. The standard triangulation language (STL) files of a premolar and a molar were obtained considering the coronal anatomy up to the cement-enamel junction (CEJ). After a healing period ranging from 1 to 3 months depending on the location of the surgical site, namely, mandible or maxilla, a digital impression was taken. The functional implant prosthodontics score (FIPS) and the numerical rating scale (NRS) of pain were recorded and compared. Results: The mean FIPS value for the test group was 9.1 ± 0.9 while the control group mean value was 7.1 ± 0.9. In the test group, pain assessment at crown placement presented a mean value of 0.5 ± 0.7. On the contrary, the control group showed a mean value of 5.5 ± 1.6. Conclusions: Patients in the test group showed higher FIPS values and lower NRS scores during the early phases compared to the control group.

Socket Shield and Bioactive Glass Around Anterior Maxilla Immediate Dental Implants

Introduction: This study aimed at testing the effect of the socket shield technique on the maintenance of the labial plate of bone and the change in position of its surrounding gingival soft tissues upon the immediate placement of 3 different dental implants systems, with a bone graft material filling the defects around the implants, followed by clinical and radiographic evaluation using the cone beam computed tomography after 4 and 12 months of loading.Materials and Methods: Three groups, 6 male patients each, having a failing central or lateral maxillary incisor, had their failing tooth partially extracted, with the remaining tooth half reduced to be the socket shield, then the 3 groups received 3 different dental implants systems, the Tapered Internal implant RBT Laser-Lock for group I, the Touareg-S implant for group II, and group III received the Nobel Active implant. Then, the Novabone putty bone graft was dispensed in the space between the implant and the shield and covered with a customized healing abutment. After 4 months of healing, the patients were provided with definitive restorations, and followed after 4 and 12 months for gingival recession, papillae filling the interdental spaces, and CBCT evaluation of the labial plate of bone width and vertical resorption. Each result was then statistically analyzed.Results: For all the cases in the study, no implant failed, no gingival recession was recorded, and the interdental papillae filled their spaces in most of the cases. also, no significant changes were recorded for the labial plate of bone width or height.Conclusions: The socket shield technique was able to maintain the labial plate of bone and the position of the overlying free gingival margin, with the neighboring interdental papillae showing least dimensional changes.