In house custom abutment: an essential complement for long term success?

87 Rating(s).


Posted on By armando ponzi In CBCT & CAD/CAM

Dear collegues, this is the work on progress about inhouse project possibility offered by the digital dentistry.
I’m just about to complete the entire inoffice cycle:
initial data (Impression digitalized or digital and CBCT)
Planning process with items production (surgical stent, custom abutment and provisional)
Immediate or delayed post production (Custom abutment provisional and final crown)
The case presented shows this new possibility of inhouse abutment using a ‘premilled‘, a titanium piece that incorporate the implant connection.
A conventional model was extra-orally scanned and abutment planned, respecting quote, subgingival margin, and harmonius emerging profile with a stable switched platform connection. The cement removal is, on this way, a sufficiently easy and predictable procedure.
Please do note the maintenance of tissue volume at 3 months from PET (on the 3 roots)and immediate extraction procedure.




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18 Comments

Armando. Beautiful looking tissue! I love this concept. I would prefer a 2 or 3 piece off the shelf solution. Abutment versatility may be a valuable tool to guide tissue migration. I will explain further in Madrid. Great work my friend. See you soon! Chuck


Reply

Chuck, thanks for kind word. Looking forward to meet you in Madrid. Armando


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Hi Armando! Can you show pre-milled abutment please? What milling unit you utilized? Gregory


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Gregory,
I sent on photo the premilled configuration:
on one side it has a connection to the millimg machine and on the other the implant connection.
Milling machine brand is Amann-Girrbach.
Thanks for comment.
Armando

premilled


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Armando, great PET response! I would like to see finished case. Please update.
What digital scan has you used?
Regards,
Jorge


Reply

Jorge sure I will update, just in a few days. I had some problem with Trios, so I went through a model and an extraoral scanner (brand: Open Technology). I' ll be glad to tell you more when we'll meet on Madrid. I'm sure you'll be quite busy the incoming days:). Best regards. Armando


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Armando:
This is gourgous. Tissue healing optimization is an overlooked parameter, IMO.
Optimizing the healing abutment may prove to be a valid answer if we were able to create a streamlined approach.

Salah


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Salah, I believe you got the point: 'streamlined approach' are the magic words. I believe that we are what we do every day: so, doing inhouse all that, it could lead to a daily dentistry approach and streamlined. It is not an easy task but we (Stefano,myself and my Team) are daily working on it. Hope to share more results with abutment delivered in post production the day of surgery. See you in Madrid, my friend. Armando


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Ciao Armando

I agree 100% w the above comments.
Its more than just surgery its Art...
I also use this abutment / crown relationship in many cases with very nice results. I do not like to go below the gingival margins for the cement complications and its so much easier for cleaning in my animal patients...

How did you get that texture on the abutment ?

The pics are custom abutment/crown at 13months

Rocco

Digital Prep
Custom Abut/Crown 13 Mo


Reply

Armando
nice case - couple questions for you when you say you scanned a Extra oral did you scan the stone model and then scan the implant ones healed? When you say pre-milled- titanium base i.e. similar to a ti base and then you milled in house? Will you also mill the crown in House this looks like an itero scanned process I am interested to know how long it takes you timewise to design and mill the abutment and then what your thoughts are on cost savings in-house versus sending to lab or mailing center

I must commend you on doing great work and a valuable contributor to the site

Cheers

Richard


Reply

Richard, a stone model including the analog was scanned using a scan transfer. The design of abutment was obtained using Exocad. I work on a team basis so I give indication how to design the abutment to Stefano (this can be done in 15/20 minutes). The milling takes about 35 minutes and can immediately produce the crown on top on any material from disilicate o zirconia. The cost per se is low but the milling machine, scanner and program are on your budget: outsourcing is cheaper. The only main difference is that if you want to do a 1 visit program or a custom 1A1T in post production, I guess this is the only way. Thanks for kind word and I hope I answered to your questions. Armando


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Dear Rocco,
I know how involved you are on digital and it is a pleasure for me to have your friendship and comments on my cases.
I believe it is a unique possibility for both of us to share same vision in different patients.
Thanks Rocco.
Armando


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State of the art Armando.

Which implant system is this, and which scan body did you use?

Regards


Reply

Andoni, thanks for kind words. Implant is Osstem but I will use DIO Implants on future works. Scan body is quite a problem at the moment as very few are adequate for all the steps required to final production. The one used here is provided by the milling machine brand and works either with Exocad and the CAM phase. Best regards. Armando


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Excelente trabajo Armando !!! Muy buena la estabilidad de los tejidos !! Excelente flujo de trabajo digital felicitaciones.


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This is the case finished with crown in place made with lithium-disilicate. Cement line is within a phisyologic area and therefore easily detected and removed. Emergence profile and soft tissue volume look very natural and maintained. Long term follow up is required but this is, IMO, a not common result at 6 months time. Thoughts about it? Armando


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Armando. Baseline is as close to perfection as I have every seen. Now all we need to observe over time, knowing there is a BIOLOGIC POSSIBILITY OF TISSUE MAINTENANCE. My experience to date with traditionally established protocol has demonstrated continuous BIOLOGICALLY BASED TISSUE LOSS over time. At what point do we as abandon tradition? Great case my friend! Thank you for sharing. Chuck

Baseline traditional approach 2008
Traditional outcome 8 years later


Reply

Chuck, gingival variation is a process that we can only modulate. The fate of recession, in time, resides on mulple factors that makes any procedure unpredictable in future. Here 2 new factors: -PET may guarantee 3D stability in time. -There's a large amount of keratinized tissue. See you in a 8 yrs time :). Armando


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