It’s 2014 and I strongly advocate the use of in-office abutment fabrication. However, the one size fits all approach is not always best. This is an example of a limitation of in-office abutment fabrication.
On the surface the implant provisional below looks well done. Picture from immediate delivery.
A closer look at this case will show that the abutment selection and design is greatly affected by the implant placement.
Implant Position. it’s non ideal. The implant is angled to the distal and to the facial. Being angled to the facial means we are now looking at a cemented restoration. This can be easily managed. However, the distal angulation really presents a tissue mangement issue.
Papillae. Remember that the ‘bone sets the tone’ when it comes to tissue and this rings very true for papillae. We know from out aesthetic lectures that we can, on average, expect about 5mm of papillae fill from interproximal bone height on a tooth-tooth situation. This number decreases to 4.0 to 4.5mm when looking at tooth-implant. When we get to implant-implant situation the number drops to about 3.5mm.
So when the implant is tilted to the distal we are potentially affecting the interproximal bone height on the distal. Now if we utilize an abutment with a wide platform we risk ‘choking’ what bone may remain.
Close inspection above will show the implant abutment is wider than the implant head and thus will put pressure on the interproximal bone. This could potentially lead to bone resorption interproximally – which would lead to papillae loss.
In a case like this the chairside TiBase (pictured above) is not the best option. Instead a custom abutment that would allow a thinner neck emergence would help protect the bone and papillae.
Anterior implant aesthetics are much more than about the ‘white’. The ‘pink’ plays a tremendous role and the pink is greatly affected by implant selection, implant position, and abutment design.
What is the root cause of this issue – non ideal implant placement. It may be integrated, the head may be pretty close to center, but the nuances make this case somewhat unpredictable.
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