Working hand-in-hand with implant manufacturers, Keating Dental Arts’ expert CAD/CAM technicians design custom dental abutments to ideally suit your patients’ anatomy and indications, then send designs to be fabricated by manufacturers to guarantee perfect interface with implant platforms and FDA 510(k) compliance. We partner with 12 major implant companies, including Nobel Biocare®, Straumann®, Atlantis, Biomet 3i® and Zimmer. Because KDA partners with manufacturers to fabricate genuine custom abutments rather than producing them in house like many labs do, our abutments are protected by manufacturers’ warranties, and do not void the warranty of the implant when seated.
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We’re really known for our ceramics, especially our Zirconia crowns but also we do unbelievable and, I think, unmatched implant supported restorations. Now when a doctor sends us a case where there was an implant placed now we need to restore, we along with the doctor will choose which type of abutment or what’s going to go on top of that implant so that we can put now a tooth on top of that abutment.
There’s basically two categories. One is what we call stock. These are basically, not one size fits all but there’s different ones that are pretty much standardized. If the implant is placed in the exact correct position and there’s not a lot of changes in the gum or the gingiva. Typically we’ll use a stock abutment which are almost always metal. We’ll use that in the back of the mouth.
The second are our custom abutments which most doctors now are using because it gives us more control. Often times when the implant is placed, because of the density of the bone or where there is bone, the implant can’t be placed perfectly where myself or your dentist would like to place the final restoration. Now we need to have an abutment, something we can build the tooth on top of, to be customized to adapt for that implant being placed maybe not ideally or if the gum tissue, the gingiva, is such that there may be a compromise and we want to make sure this implant crown looks as natural as possible.
The custom abutments can be made of several different materials. One is metal. The way these are fabricated are almost like gold ring are fabricated. It’s actually waxed to ideal. It’s invested then we burn out that wax pattern. Then we take metal and we either cast it into that burned-out investment or we actually design it via CAD/CAM and we mill it. Advantages and Disadvantages of Metal Abutments
The advantage of the metal is we’ve been using it a long time. We know it’s strong. The disadvantage of metal is it’s grey or gold and so it limits what we can put on top of that as far as a very translucent crown. Although there’s many doctors still using metal abutments, this category has really decreased in the last four or five years.
The other option we have is what we call a zirconium oxide abutment. Zirconium oxide is a very, very strong ceramic. In fact the strongest ceramic we have. It can be either made white or tooth colored. The advantage of a tooth-colored abutment is that now we can put a very translucent crown on top of that abutment so that it looks more like a natural tooth in zirconia. The zirconia can either be solid zirconia or it can actually have a metal or titanium base. As the abutment is screwed down on top of the implant, we have metal against metal. A lot of clinicians, including myself, prefer metal against metal versus a solid monolithic zirconium abutment but that certainly is an option.
The next option is what we call our H abutment. With the H abutment, we can use zirconia but frequently we use lithium disilicate which Ivoclar offers as e.max. A lot of the clinicians and the dentists who are listening to this are saying, “I use that for crowns and inlays and onlays and veneers.” Same material.
What we do is we take the titanium base. You have the titanium base that would fit into the implant. Here’s our implant. Then it actually has a channel and this is where your screw would go through. With this titanium base now we can build an ideal abutment around that channel.
The advantage of lithium disilicate is it can be dentin shade. Really it’s really unlimited how many shades, how many dentin shades we can fabricate that out of. Also lithium disilicate, when it’s etched in the laboratory with hydrofluoric acid, it’s very bondable. If we have short clinical crown height or the implant is angled in such a way that our abutment doesn’t have a lot of natural retention then, at the laboratory, Keating will go ahead and etch this abutment and then you can use either a veneer or a very thin all ceramic crown and bond it to that abutment.
You can see we have different options. What’s the best option? It really depends on the circumstance and obviously your patients needs. We’ve got to look at function and occlusion, where the implant crown is going to be placed in the mouth. Steve Tapie who is the manager of our implant department is unbelievable at answering your questions. If you have any concerns or questions about when you should use what and this really should start in the planning phase, where the implant should be placed, when you work with the surgeon, maybe what kind of implant you want placed because different implant manufacturers give us more options. Some of the implant manufacturers give us less options.
You can certainly contact Steve. You can send him a radiograph. He’ll talk to you about different abutments that are available. If the implants already been placed, he can give you some guidance in how do we move to the next direction to get, not only the best aesthetics but the long-term function for our patients.
I tell my patients in my practice when they ask, “How long will implants last?” Potentially forever as long as they maintain it, good oral hygiene, it was placed properly and we place an ideal abutment and crown that’s loaded properly and is not stressed. That can last for a very long time.
Hello, I’m Dr. David Hornbrook, the clinical director of education and technology here at Keating Dental Arts in Irvine, California. I want to talk today about implants, what I call chair-side implant tips. At Keating we do a lot of custom implant abutments and implant restorations, not only abutments, customs, and standardized, but also the restorations. As I walk around the floor here in the laboratory, I see a lot of very common mistakes and errors that clinicians are making and we’re going to talk about how we can avoid those. As we talk about these, some are going to say, “Aw I do that all the time,” and we should and a lot of you do, but I see it enough that I think we need to pay attention to some of these tips.
The first one, is take a PA or bitewing of the transfer post before you take your final impressions. I see this all the time and we have to send it back and say take it again, which is frustrating as a laboratory, but it’s certainly frustrating for you, as a clinician, and your patient. When we put our transfer post in, if it’s a hex, make sure it’s seated all the way. If it’s a lobe type transfer post, make sure it’s seated all the way. Take a radiograph. If you’re concerned, maybe you’ve never seen that implant before or it’s one where there’s a transfer in the diameter of the base, send it up to Steve at Keatingdentalarts.com. He’s unbelievable. He’s our implant manager that specializes in abutment dental implants, dental crown implants, custom implant abutments among others. He’ll look at, he’ll call you right back or email and say yup seated all the way or not.
Also, only hand tighten your transfer post. Don’t use a torque for the transfer post. The screw isn’t designed to be torqued hard. The metal of the transfer post can distort a little bit if you tighten it too much. Just hand tighten it. Now, when you do have it tightened with your driver, remember there’s a screw hole on the top, whether it be a hex or whether it be a star-type driver. Plug that screw hole before you take your impression. I like to use a little ortho wax or you can use a little impression material or you can use a tempering material. You can use a pellet or a piece of one, I’d rather not use that.
What would happen if you don’t plug your screw hole and the impression material goes in there, then you take out your impression, unscrew your transfer post, sometimes that won’t seat all the way because of that little remnant of the impression material that went to that screw hole. One of the things that Steve does here, he gets under a scope at 20 power, he’ll have to take a surgical blade and actually take that away, but let’s avoid it in the first place. Plug the screw hole.
Next is make sure that you have enough impression material that surrounds the entire impression post because what happens is a lot of these transfer or impression post are long and if you don’t completely cover them with the impression material, they’re not stable and we go to try to seat them and there’s wobbling. If that happens you’ll be able to cut that out. If you don’t have impression material completely surround that post, remember they’re long, as we go to insert that into the impression, we don’t get stability and we can move around within that impression. Then there’s a chance that when we put the analog on, that that won’t be accurately transferred to the stone model.
Next is don’t use a triple tray. I know a lot of you do and it’s fine for single units, but not implants. We need as much material and rigidity in the impression as possible. We’re inserting that long transfer post into the impression, it needs to be completely stable and we put the analog on, it needs to be transferred and reproduced in the stone model. Don’t take a triple tray. Use a full arch tray, make sure the sides are high enough and long enough that we get a very rigid impression. Next I would recommend send the surgeon’s letter on what type of dental crown implant they used or maybe you placed the implant. Make a little photocopy of the little box the implant came in, send that along with your prescription. It just makes everything so much more seamless as we can see the overall goal of the case, exactly what was used.
Next, don’t reuse the analog. They’re not really that expensive. The transfer post we can reuse, but not the analogs. What can happen is if you try to take it out of the stone model, and we’ve even had doctors that prescription say remove the analog from the stone model and send it back with the case. As we take it out of the stone model, we can actually distort that or we can bend it a little bit inadvertently and then you won’t, for your next case, you won’t get accurate representation where that analog should actually go.
Hopefully little tips … There’s not a lot and again they seem so obvious. Pay attention to these and what you’ll find from Keating is you’ll get implant abutments and their corresponding crowns back that look great, that fit, that meet all the criteria that you would expect from an implant supported restoration.
I hope you enjoyed this tip. Again, it may seem obvious, but our goal at Keating is to make sure every restoration, especially implant-supported restorations, that you receive back from us, meets your criteria, as well as your patients.
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