The Invisible Implant Abutment System

The Invisible Abutment System is the strongest, most esthetic restorative option for implants today.

 

What are the implant restoration challenges we face every day?

#1   EXCESS RESIDUAL CEMENT

Close to 80% of implant failures are attributed to excess cement. Cement retained restorations are the standard for restoring dental implants.   Therein lies the problem.

Quoting from Wilson TG Jr. J Periodontal, 2009 September

“The positive relationship between excess cement and peri-implant disease: A prospective clinical endoscopic study.

METHODS: 39 consecutive patients with implants exhibiting clinical and/or radiographic signs of peri-implant disease were studied. Patients were enrolled in the study during a 5 year period in a private periodontal practice. Twelve of these patients had similar implants without signs of inflammation; these implants served as controls. There were 20 controls and 42 test implants. All were evaluated using a dental endoscope initially, all but one implant was evaluated at a 30 day follow-up. Results from both groups were assessed by two trained operators and recorded.

RESULTS: None of the controls and all 42 of the test implants had clinical signs of peri-implant disease at initial treatment. Excess cement was found in none of the controls and 34 of the test sites. Thirty days after cement removal, 25 of 33 test sites from which the cement was removed had no clinical or endoscopic signs of inflammation.

CONCLUSIONS: Excess dental cement was associated with signs of peri-implant disease in the majority (81%) of the cases. Clinical and endoscopic signs of peri-implant disease were absent in 74% of the test implants after the removal of excess cement.”

 

We will conclude that excess cement should be avoided.

#2   STOCK ABUTMENTS

Most posterior and some anterior applications are fine for a stock abutment. What about those circumstances where a stock abutment is clearly contraindicated. Do you force the issue and use it anyway because the oral surgeon already sold it to the patient? Do you use it anyway just because you have it ready to go and a custom abutment will take more time and possibly be more expensive?

Possible contraindications for a stock abutment:

  • It is too short for proper retention
  • It is on a poor angle
  • It has a poor emergence profile
  • The color will show through
  • The margin is too deep for cement clean up
  • The margin is supragingival and unacceptable by the patient
  • You are restoring a cosmetic/complex case

 

#3   TITANIUM CUSTOM ABUTMENTS

Possible contraindications for a titanium custom abutment:

  • Poor emergence profile trying to hide metal
  • The color will show through
  • You are restoring a cosmetic/complex case

 

#4   ZIRCONIA STOCK OR CUSTOM ABUTMENT

Possible contraindications for a zirconia stock or custom abutment

  • Zirconia with no metal base is contraindicated because of deficient strength.
  • Custom zirconia with a titanium base is contraindicated for most applications because of poor strength. It should be utilized only where strength will not be an issue.

 

#5   SCREW RETAINED ABUTMENT/CROWN

Possible contraindications for a screw retained restoration

  • The screw access is too far facial to be unacceptable.
  • Restoring a cosmetic/complex case, it can be limiting.
  • The access is limited according to the patient’s ability to open, primarily for 2nd and 3rd

 

#6   THE REVERSE CEMENT TECHNIQUE

I will attempt to explain this one because not everyone is familiar with it. In experienced hands it has proven to be a good technique.

Using a stiff putty, fill the inside of the crown to be cemented on the abutment. After it is set, remove it and place some cement into the crown. Push the putty in to within .2mm of fitting all the way in. The excess cement is expressed and wiped clean. Remove the putty and place the crown on the abutment, seating fully. There should be very little cement expressed.

Possible contraindications for the reverse cement technique

  • It takes a few dry runs to get it right
  • There still may be a small amount of excess cement
  • It tends to be messy and unpredictable

These are the most popular choices we have when restoring implants.

 

The Invisible Abutment System is the one restorative option we have that answers all of the challenges listed with the most popular choices that have been presented.

 

What is the Invisible Abutment System?

The Invisible Abutment is made with a metal substructure much like a PFM. With the UCLA abutment from the chosen implant company, we wax to full contour for the ideal emergence profile and tooth placement. The correct angle, length, and margin depth are created in wax.

Cast in a semi-precious metal for strength, it is then opaqued and layered in the exact shades as the final restoration. Even the margin is layered with translucence for life-like beauty. The margin is placed 1mm. below tissue for simple cement clean up. The abutment is layered in ceramic the exact shade of the crown. Next we press an eMax to fit the Invisible Abutment.

The two are seamless in fit and color.

Simply torque the Invisible Abutment to place and cement the eMax crown.

Far stronger and more life-like than zirconia, The Invisible Abutment answers the call to strength and better predictability.

 

In fact, as we compare to all of the previously mentioned challenges with the most popular restorative choices, we can surmise the Invisible Implant Abutment answers every challenge. We now have a new and better arrow in our quiver of restorative choices.

 

Scott Emett

See more at ScottEmett.com

Or at Riversideds.com

 

 

 

 

 

 

 

 

 

 

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