Custom Abutments Research Articles

Implant Angulation Effect on the Fracture Resistance of Monolithic Zirconia Custom Abutments: An In Vitro Study.

To investigate the fracture resistance and performance of zirconia when employed for the fabrication of implant abutments with different angulations, simulating anterior maxillary oral rehabilitation. Forty-five monolithic zirconia custom abutments of internal conical implant connection were CAD/CAM designed and fabricated. The specimens were divided into three groups (n = 15/group) according to implant-to-abutment angulation. The angulations used were; 0°, 15°, and 25°. The abutments were loaded until failure at 135° using the Universal Testing Machine (Instron, Canton, MA). Collected data were statistically analyzed using one-way ANOVA and post hoc Tukey test. Mean (±standard deviation) load at fracture of the zirconia abutments for the three groups were 962.37 ± 93.81 N (Gr15) > 718.25 ± 93.71 N (Gr25) > 534.05 ±133.77 N (Gr0). Statistically significant difference (p < 0.0001) was found between all groups; Gr0 vs. Gr15, Gr0 vs. Gr25, Gr15 vs. Gr25. Contrary to expectations, the non-angulated monolithic zirconia abutments presented the lowest fracture resistance values. Angulating the abutments 15 or 25 degrees, following the palatal resorption pattern of the premaxilla, significantly increased the in vitro fracture resistance.

The behavior of a zirconia or metal abutment on the implant-abutment interface during cyclic loading

Statement of problemThe effect of different abutment materials on the misfit and stability of the implant-abutment assembly under cyclic loading is unclear. PurposeThe purpose of this in vitro study was to evaluate the initial misfit, final misfit, and wear of external hexagon zirconia and metal implant abutments upon cyclic loading. Material and methodsForty 4.1-mm regular platform external connection implants were divided into 4 groups with 10 specimens in each group. The prosthetic abutments tested included Completely cast group (CC) (antirotational, castable burnout, custom abutment completely cast in nickel-chromium-titanium), Overcast group (OC) (Co-Cr premachined, antirotational, custom burnout abutment cast in nickel-chromium-titanium), Zirkonzahn group (Z) (antirotational castable, custom Y-TZP abutment produced; Zirkonzahn Prettau), and Neodent group (N) (antirotational castable, custom Y-TZP abutment; Neoshape). Abutments were fixed to the implants with 20-Ncm torque, and all specimens were cyclically loaded at 300 N with 9 Hz for 1 million cycles. The misfit on the implant-abutment interface was evaluated before and after cyclic loading by using an optical linear measuring microscope. Then, the wear of the external hexagon was analyzed by scanning electron microscopy (SEM) at a magnification of ×120. For a statistical analysis, a 1-way ANOVA was used for wear values. The data for the gaps were analyzed with a 2-way ANOVA. Any significant differences were resolved by using the Tukey HSD test (α=.05). ResultsThe CC (37 ±8 μm) and OC (35 ±5 μm) groups showed significantly larger initial misfit than the Z (4 ±5 μm) and the N (2 ±4 μm) groups (P<.05). After the mechanical cyclic loading, a statistically significant difference was found between the CC group (58 ±9 μm) and the other 3 groups (P<.05). The OC group (41 ±4 μm) showed significantly larger final misfit than the Z (19 ±7 μm) and the N groups (20 ±4 μm) (P<.05). Despite significantly increased misfit in all groups (P<.05), the OC group showed significantly less increased gap (6 μm) than the Z (15 μm) and the N (18 μm) groups, while CC showed the most increase in misfit (21 μm). Conversely, N (1313 ±315 μm2) and Z (735 ±126 μm2) groups showed significantly higher wear rate on the hexagon of external implants. The CC (231 ±182 μm2) and OC (201 ±125 μm2) groups were not statistically different. ConclusionsDifferent materials and fabrication techniques resulted in different levels of misfit at the implant-abutment interface. The mechanical cyclic loading aggravated the misfit, regardless of material or fabrication technique. In addition, the difference in the hardness of the abutment materials may lead to different levels of wear on the external hexagon. Zirconia abutments had increased wear and misfit. Premachined, antirotational, castable custom dental implant abutments had the least amount of change in misfit, which may indicate long-term stability at the implant-abutment interface.

Displacement of Customized Abutments Designed on a Working Cast and in the Oral Cavity: A Comparative In Vivo Study.

To compare abutment displacement between the virtual, customized abutment that was designed on a cast and the customized abutment prepared in the oral cavity. Eleven patients were selected for a single posterior implant prosthetic treatment. The impression was obtained using the closed tray impression method with a vinyl polysiloxane material using a custom tray. The standard tessellation language files of the customized abutment that was designed using the computer-aided design system and acquired with an intraoral scanner in the oral cavity were superimposed and analyzed for distance and angle displacement using the three-dimensional inspection analysis program (Geomagic Control X). In the statistical analysis, distance and angle displacement values were analyzed with the Kruskal-Wallis H test (α = 0.05), and a post hoc comparison was performed using the Mann-Whitney U-test and Bonferroni correction method. The mean distance and angle displacement of the 15 customized abutments were 89.52 ± 66.86 µm and 0.83 ± 1.21°, respectively. There were significant differences in distance displacement (p < 0.001), and angle displacement (p < 0.001) among the 15 customized abutments, and there were no significant differences in angle displacement along the 4 directions (p = 0.735). The displacement values of the customized abutments evaluated in the oral cavity differed significantly from patient to patient.

Prediction of learning curves of 2 dental CAD software programs, part 2: Differences in learning effects by type of dental personnel

Statement of problemDental computer-aided design (CAD) software programs are essential elements of the digital workflow. Therefore, it is necessary to study the learning effect of dental CAD software programs for efficient use. PurposeThe purpose of this in vitro study was to predict the learning curve of dental CAD software programs according to dental personnel by using the Wright model and to investigate the tendency of dental personnel to reduce working time according to repeated learning. Material and methodsA total of 36 participants were recruited, including an equal number of dentists, dental technicians, and dental students (12 each). A custom abutment design was evaluated by using exocad CAD and Deltanine CAD software programs. The design was carried out in the following order: 4 steps repeated 3 times each. This study applied the formula of the Wright model to predict 500 repetitive times. In the statistical analysis, 3-repetition and 500-repetition times were analyzed with the Kruskal-Wallis H test and Friedman test (α=.05), and a post hoc comparison was performed by using the Mann-Whitney U-test and Bonferroni correction method (α=.017). ResultsThree repetitions resulted in shorter working time in the dental technician group. The 3-repetition time decreased statistically for all dental personnel (P<.001). The time for 500 repetitions showed a statistically significant difference according to the type of dental personnel (P=.036), but no significant difference was found after the fourth iteration (fifth iteration: P=.076). Furthermore, the estimated time of 500 iterations decreased statistically significantly from the first to the 500th iteration (P<.001). ConclusionsAll dental personnel showed learning effects of dental CAD software programs. Although the dental technician group initially showed less working time, after initial learning, the same learning effect appeared, regardless of the type of dental personnel.

Fracture Resistance of Additively Manufactured Zirconia Crowns when Cemented to Implant Supported Zirconia Abutments: An in vitro Study

To compare the fracture resistance of implant-supported milled zirconia, milled lithium disilicate, and additively manufactured zirconia crowns. Maxillary cast with a dental implant replacing right second bicuspid was obtained. Custom abutments and full-contour crowns for milled zirconia, milled lithium disilicate, and additively manufactured zirconia crowns (n = 10/group) were digitally designed and fabricated. The crowns were cemented to implant-supported zirconia abutments and mounted onto polyurethane blocks. Fracture resistance was determined by vertical force application using a universal testing machine at a crosshead speed of 2mm/minute. Kruskal-Wallis test was used to analyze data and failure mode was determined for all the groups. Milled zirconia crowns demonstrated the highest median fracture resistance (1292±189 N), followed by milled lithium disilicate (1289±142 N) and additively manufactured zirconia (1243.5±265.5 N) crowns. Statistical analysis showed no significant differences in fracture resistance between the groups (p = 0.4). All specimens fractured at the implant-abutment interface. Additively manufactured zirconia crowns demonstrated similar fracture resistance to milled ceramic crowns, when cemented to implant supported zirconia abutments. The results of this in vitro study signify the promising potential of additive manufacturing for the fabrication of all ceramic zirconia crowns.

Titanium implant wear from a zirconia custom abutment: A clinical report

This clinical report describes damage to a 1-piece zirconia abutment where both biological and mechanical complications developed, resulting in premature loss of the implant. Scanning electron microscopy showed significant damage to the internal connection of the implant. When using 1-piece zirconia abutments with a titanium internal connection, periodic recall and identification of wear is necessary, especially in patients with repeated screw loosening.

Digital Tissue Preservation Concept: A Workflow for Guided Immediate Implant Placement and Restoration

The digital workflow presented here allows for fabrication and placement of a definitive custom abutment at the time of tooth extraction and guided immediate implant placement, thus preserving soft tissue anatomy. Since abutment design was based on the shape of the original tooth, it represented a de facto emergence-analog that provided ideal soft tissue support. The approach of superposing and merging of custom abutment design data with data captured intraorally after abutment placement enabled a digital impression without gingival displacement and associated trauma. The generated data facilitated the fabrication of a precisely fitting restoration concurrent with the implant healing period.

Accuracy of Customized Prefabricated Screw-Type Immediate Provisional Restorations after Single-Implant Placement.

Limited evidence is available comparing the differences between pre-operative and post-operative 3D implant positions from the viewpoint of prosthetics. We aimed to investigate the differences between preplanned positions of virtual provisional restorations and their actual positions following fully guided single-implant placement. Ten maxillary typodonts with missing right central incisors were imaged using cone-beam computed tomography, and digital impressions were obtained using an intraoral scanner. These data were imported into implant-planning software, following which the provisional restorations were designed. After data superimposition, an appropriate implant position was determined, and a computer-assisted implant surgical guide was designed for each typodont. Orders generated from the implant-planning software were imported into relevant computer-aided design software to design the custom abutments. The abutments, provisional restorations, and surgical guides were fabricated, and each restoration was cemented to the corresponding abutments, generating a screw-type immediate provisional restoration. The implants were placed using the surgical guides, and the screw-type provisional restorations were engaged to the implants. The typodonts were then rescanned using the intraoral scanner. The restorations designed at the treatment planning stage were compared with those in the post-operative scan using metrology software. The angular deviation around the central axis of the implant was measured, and the differences in the crown position were converted to root mean square (RMS) values. The post-operative provisional restorations exhibited an absolute angular deviation of 6.94 ± 5.78° and an RMS value of 85.8 ± 20.2 µm when compared with their positions in the pre-operative stage. Within the limitations of the present in vitro study, the results highlight the potential application of customized prefabricated immediate provisional restorations after single-implant placement.

Axial displacement in cement-retained prostheses with different implant-abutment connections.

The purpose of this study was to evaluate axial displacement in cement-retained prostheses using computer-aided design/computer-aided manufacturing (CAD/CAM) abutments with three different types of implant-abutment connections. CAD/CAM abutments made with two types of titanium blocks (made by the same manufacturer as the implant manufacturer and by a manufacturer with a patent for CAD/CAM abutment fabrication) were connected with three types of implant connections: external, internal butt, and internal conical connection. Titanium custom abutments and zirconia prostheses were fabricated using the CAD/CAM system for each specimen. The geometries and surface morphologies of CAD/CAM abutments and ready-made abutments were comparatively evaluated using scanning electron microscopy. Cemented prostheses on abutments were mounted on a universal testing machine and subjected to 250-N sine wave cyclic loads. Cumulative axial displacement was measured at loading cycles of 3, 10, 100, and 106 and analyzed by repeated measures analysis of variance (ANOVA). Surface geometries and morphologies of CAD/CAM abutments varied according to the implant-abutment connection and manufacturers of the titanium block. The internal conical connection exhibited the greatest axial displacement, while the external connection showed the lowest axial displacement. The CAD/CAM abutment made with a compatible titanium block exhibited a greater axial displacement than that exhibited by the abutment fabricated using a titanium block made by the implant manufacturer. In implant connections with a vertical stop, axial displacement occurred primarily in the early loading period and was self-limited. However, long-term axial displacement can occur with internal conical connection implants. Therefore, in internal conical connection implants, axial displacement should be managed more carefully using a provisional restoration, with consideration of the abutment fabrication method.

Immediate implant and customized abutments: Esthetic peri-implant preservation alternative without immediate loading esthetic customized abutment

The aim of this case report was to describe an alternative treatment for the healing and maintenance of peri-implant mucosa in esthetical region. Managing the peri-implant soft tissue is one of the most challenging tasks in anterior implant esthetics, especially when replacing a failing tooth. However, not all patients underwent extraction, and immediate implant placement can receive loading, conducting to uncertain predictability. This is a case report that describes an alternative treatment for the healing and maintenance of the peri-implant mucosa in an esthetically significant region, through the use of a customized abutment to obtain an emergency profile when there is insufficient torque for immediate implant loading. The present technique was able to ensure not only healthy peri-implant soft and hard tissues, but also esthetic maintenance of the anterior region for immediate implant placement. This clinical case demonstrates a different manipulation technique from the peri-implant soft tissues in immediate implants of the esthetic region favoring the peri-implant health and clinical results, promoting treatment success, and patient satisfaction.

Comparison of the effects of cement removal from zirconia and titanium abutments: An in vitro study

Statement of problemExcess cement around dental implants is a significant cause of peri-implant inflammation. Research has focused on approaches to cement removal, the type of cement used, and the different instruments used for cement removal with titanium abutments. However, data comparing zirconia with titanium abutments are lacking. PurposeThe purpose of this in vitro study was to compare the effectiveness of excess cement removal from zirconia and titanium custom abutments using an explorer and to compare the effects of cement removal on the abutment surfaces. Material and methodsImplant analogs were placed in a cast in the position of the 2 maxillary central incisors. After creating similar emergence profiles for both the implant abutments, 18 zirconia and titanium custom abutments were fabricated with 1-mm subgingival finish lines on the facial and interproximal areas and an equigingival finish line on the palatal side. The crowns were cemented with zinc oxide-eugenol cement, and a steel explorer was used to remove the excess cement. All abutments were analyzed under a scanning electron microscope for cement remnants and scratches. ResultsThe mean surface area of cement remnants on the zirconia abutments was 778 ±113 μm2, and for titanium abutments, it was 1123 ±252 μm2, which in terms of the mean percentage area was 3.27% of the total surface area of zirconia and 4.71% of titanium abutments. Only a few abutments from each group showed scratches, and no deep scratches or gouges were observed. ConclusionsZirconia and titanium abutments had statistically similar cement remnants. Scratches were observed on only a few specimens.

Effect of Angle and Type of Customized Abutment (Castable &amp; Cast-to) on Torque Loss and Fracture Resistance After Cyclic Loading

Background: Implant placement with more than 25° angle and use of customized abutments are still challenging in implant dentistry. Also, casting is still the most commonly used method for fabrication of customized abutments. Objective: This study evaluated the effect of angulation and type of abutment (castable and cast-to) on torque loss and fracture resistance after cyclic loading. Methods: Two implants were mounted with 0 and 30° angle on a gypsum model. Castable and Cast-to abutments were casted by cobalt-chromium alloy on each implant (10 samples in 4 groups). Rotational freedom was measured by a video-measuring microscope. The reverse torque values before and after cyclic loading (500,000 cycles) were measured by a digital torque-meter. Abutments were subjected to fracture resistance test in a universal testing machine. Data were analyzed using the Kruskal Wallis, two-way ANOVA and repeated measures tests. Results: Difference between castable and cast-to abutments regarding rotational freedom was not significant. Torque loss in castable abutments was significantly greater than cast-to abutments before and after cyclic loading (P &lt; 0.05). The effect of abutment angle on torque loss before and after cyclic loading was not significant. Conclusion: Irrespective of the abutment angle, torque loss was significantly higher in castable groups. Considering the high fracture resistance, abutment fractures were not clinically an issue.

Thickness of the buccal bone wall and root angulation in the maxilla and mandible: an approach to cone beam computed tomography

BackgroundThe objective of this paper is to anatomically describe the bone morphology in the maxillary and mandibular tooth areas, which might help in planning post-extraction implants.MethodsCBCT images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to December 2014. The thickness of the facial wall was measured at the crest, point A, 4 mm below, point B, and at the apex, point C. The second parameter was the angle formed between the dental axis and the axis of the basal bone.ResultsA total of 403 teeth were measured. In the maxilla, 89.4% of incisors, 93.94% of canines, 78% of premolars and 70.5% of molars had a buccal bone wall thickness less than the ideal 2 mm. In the mandible, 73.5% of incisors, 49% of canines, 64% of premolars and 53% of molars had < 1 mm buccal bone thickness as measured at point B. The mean angulation in the maxilla was 11.67 ± 6.37° for incisors, 16.88 ± 7.93° for canines, 13.93 ± 8.6° for premolars, and 9.89 ± 4.8° for molars. In the mandible, the mean values were 10.63 ± 8.76° for incisors, 10.98 ± 7.36° for canines, 10.54 ± 5.82° for premolars and 16.19 ± 11.22° for molars.ConclusionsThe high incidence of a buccal wall thickness of less than 2 mm in over 80% of the assessed sites indicates the need for additional regeneration procedures, and several locations may also require custom abutments to solve the angulation problems for screw-retained crowns.

Accuracy of three digital workflows for implant abutment and crown fabrication using a digital measuring technique

Statement of problemThe accuracy of a full digital workflow using an Atlantis abutment and a milled zirconia crown; a full digital workflow with a 3Shape split-file workflow using a zirconia abutment and crown; and an interrupted digital workflow using an Atlantis abutment and a milled zirconia crown is unclear. PurposeThe purpose of this in vitro study was to compare 2 full digital workflows relative to an interrupted workflow for restoring an implant with a custom abutment and crown. The secondary purpose of this study was to validate a digital means of measuring internal fit and marginal discrepancy using engineering software programs. Material and methodsThree workflows were evaluated. The first group, interrupted digital Atlantis (IDA) workflow, included a customized Atlantis abutment that was designed, received, and then rescanned for the definitive crown design. The second group, full digital Atlantis (FDA) workflow, included a customized Atlantis abutment and its corresponding standard tessellation language (STL) file, the Atlantis Core File, which was immediately imported into design software and used for crown design and milling. The third group, full digital split-file (FDSF) workflow, used 3Shape's full digital workflow for abutment and crown design called the split-file workflow, in which the crown and abutment were designed and milled simultaneously. All restorations were evaluated with standardized measurements using a scanning electron microscope (SEM) for 2D measurements, followed by standardized measurements using Geomagic Control, an engineering software program, which facilitated 3D evaluations of the specimens. ResultsThe 2 Atlantis workflows, IDA and FDA, had statistically smaller marginal openings (P=.002) than the FDSF when measured using 2D SEM. The FDA had a statistically smaller 2D SEM marginal gap than the other 2 groups, IDA (P=.002) and FDSF (P=.002). The FDA had a statistically smaller 3D Geomagic marginal gap than the other 2 groups, IDA (P=.004) and FDSF (P=.006). The FDSF had a statistically smaller 3D Geomagic internal fit than the other 2 groups, FDA and IDA (both P=.006). ConclusionsAll 3 workflows evaluated in this study showed clinically acceptable results in terms of mean marginal gap below 120 μm. The SEM evaluation of mean marginal opening revealed that IDA and FDA mean marginal openings were statistically smaller than the FDSF mean marginal opening. SEM and Geomagic measurements revealed that the FDA mean marginal gap was significantly smaller than IDA and FDSF mean marginal gaps. Geomagic evaluation of mean internal fit revealed that the FDSF was significantly smaller than IDA and FDA. The use of Geomagic to measure and evaluate mean marginal gap and mean internal fit as defined in this study proved to be an acceptable form of measurement with statistical validation.

Fits of Implant Zirconia Custom Abutments and Frameworks: A Systematic Review and Meta-Analyses.

The aim of this systematic review and meta-analyses was to evaluate fits of zirconia custom abutments and frameworks on implants and to identify the factors that influence their fits. An electronic search was conducted through PubMed (MEDLINE), Google Scholar, and Cochrane Central Registrar of Controlled Trials. The search was completed in August 2017. Series of meta-analyses were conducted to compare fits of zirconia custom abutments and frameworks on implants with metal abutments and frameworks. The interest variables were the interface gap and the rotational misfit of abutments and the vertical fit of frameworks. Initially, a total of 672 articles were identified from the electronic search. After applying the inclusion criteria, 17 suitable articles were selected, including 9 studies on the fit of zirconia custom abutments and 8 studies on the fit of zirconia frameworks. There is a tendency for zirconia abutments to exhibit greater interface gaps and rotational misfits than metal abutments. Abutments produced by manual-aided designs/manual-aided manufacturing (MAD/MAM) exhibited inferior fits compared with those produced by computer-aided design/computer-aided manufacturing (CAD/CAM). Proprietary abutments had superior fits compared with non-proprietary abutments. Milled zirconia frameworks had insignificantly inferior fits compared with milled metal frameworks. Within the limitations of this study, custom zirconia abutments and non-proprietary abutments appeared to exhibit slightly inferior fits compared with metal abutments or abutments produced by the same implant company. However, the clinical significance of this difference is yet to be determined. The fit of milled zirconia frameworks is generally comparable to milled metal frameworks.

Comparative study of two CAD software programs on consistency between custom abutment design and the output

Comparative study of two CAD software programs on consistency between custom abutment design and the output

Prediction of the learning curves of 2 dental CAD software programs

Statement of problemDental clinical procedures are being replaced by digital workflows. Therefore, the time necessary to learn dental computer-aided design (CAD) software to achieve a change in the digital workflow should be evaluated. PurposeThe purpose of this study was to predict the learning curve according to the type of dental CAD software with the Wright model and to determine the rate of improvement in the learner’s working time with iterative learning. Material and methodsA total of 40 participants with various degrees of experience with dental computer-aided design and computer-aided manufacturing (CAD-CAM) systems were recruited. The 4 specified steps of a custom abutment design were performed with 3DSystem CAD software (Daesung) and exocad DentalCAD (exocad GmbH) software and were repeated 3 times in stages. The times were analyzed with repeated-measures 1-factor and 2-factor analyses. The learning time for 300 design iterations was estimated by applying the Wright model formula, and the 300-repetition times were analyzed with the Mann-Whitney U test (α=.05). Resultsexocad had a longer mean learning time than the 3DSystem. The overall change with repeated learning was significantly different (P<.001), and all differences were found in the first to third iterations. Software-dependent differences were also observed (P=.005). The Mann-Whitney U test also revealed a significant difference between the 2 software programs (P=.015), but no significant difference was found after the 56th iteration (57th iteration: P=.051). ConclusionsAs the time reduction patterns for iterative learning differ depending on the type of CAD software, the learning curves may differ according to the type of software. As the operator’s skill increased through iterative learning, the differences in learning times between the software programs gradually disappeared.

The current considerations in the fabrication of implant prostheses and the state of prosthetic complications: A survey among the dental technicians

PurposeTo investigate the current considerations in the fabrication of dental implant prostheses (DIP) and the state of prosthetic complications from the dental technicians (DT) perspective. MethodsA self-designed pretested questionnaire and an informed consent were distributed to 150 certified DT working in dental laboratories of Riyadh, KSA. The demographic data, questions related to the implant fixed/removable prostheses and questions on the prosthetic complications related to the DIP were collected. Descriptive statistics and Chi-square test were used for statistical analysis, considering a P-value of <0.05 using SPSS. Results130 responses (response rate 83.6%) were received. 53% (n = 69) of the DT received job orders for DIP from >20 dentists. 49% (n = 64) of dentists took the leading role in the treatment planning/designing. 48% (n = 62) and 52% (n = 68) of requests were for Cement and Screw retained DIP respectively. Custom abutments 37% (n = 49) choice of abutments. Porcelain fused to metal (PFM) 34% (n = 44) and PFM with metal occlusal surface 55% (n = 71) were material of choice. 49% (n = 64) designing of implant overdentures were according to the dentist’s instructions with Ball and Socket 48% (n = 63) to be the most common attachment. DT regarded poor implant location/orientation 38% (n = 49) and inaccuracies in impression/bite-registration 40% (n = 52) as the obstacles to success. Half 50% (n = 65) of the repairs were for facing damage/chipping of ceramic. Fracture of the denture base/tooth detachment 50% (n = 65) was common with implant over dentures. ConclusionsDT played a role and took decisions regarding the DIP. Frequent problems found by DT were poor implant location, discrepancies in impression/bite-registration, facing damage/chipping and damage/fracture of the denture base/prosthetic teeth. The frequency of these complications can be minimized by an increase in the prosthetic knowledge of the dentists and establishing clear protocols for communication between the dentist and the DT.

CAD/CAM Custom Abutments for Esthetic Anterior Implant-Supported Restoration: Materials and Design

The purpose of this review is to discuss the use of computer-aided design and computer-aided manufacturing (CAD/CAM) custom abutments in the anterior region with a focus on abutment design and material selection. Advantages, disadvantages, and complications of CAD/CAM abutments are also considered. CAD/CAM abutments are available in various materials and with different connection platforms to the implant in order to meet esthetic, functional, and biological demands. Use of CAD/CAM concepts in the fabrication of custom abutments allows for definite advantages over both stock abutments and conventional cast custom abutments. CAD/CAM technology should be considered when restoring dental implants in the esthetic zone.

A technique for obtaining flawless cast-to-implant custom abutments

A technique for obtaining flawless cast-to-implant custom abutments