Custom Vs. Standard Abutments: What is the Difference in the Long Run?

If the cost of you time, until you prep. tha titanium in the mouth is less, then the lab fee for the preparatian, just do it... additionaly: -there is the possibility of overheating the implant -you can prep. it, but not so easy to get sharp impression margin (not easy to use a chord) -do the work twice is more expencive

Ahora que la sociedad científica sabe, con certeza, cuales son las superficies que mejor funcionan para que el implante se integre, la tendencia es fabricar implantes cuyo transportador pueda servir como pilar definitivo. Evidentemente, si el implante está colocado, por el motivo que sea, lejos de su posición ideal, no tendrás más remedio que utilizar un pilar calcinable, para hacer un pilar personalizado. Si, en cambio, tienes buena puntería y colocas el implante en la posición ideal, puedes usar pilares de serie, o el del implante (transportador). En este último caso, la altura gingival debe coincidir con la diseñada en el transportador, que no da muchas posibilidades. En definitiva todo depende del caso. la cosa se te complica si quieres usar prótesis cementada, con pilares de serie, cuando hay mucha altura hasta el antagonista. Mejor en este caso usar pilares personalizados. Saludos. Dr.José Mª Sancho - BARCELONA

I only use custom abutments. Atlantis to be specific. The quality, time and "sweat equity" more that pays the difference in cost.

Don't stop using custom abutments where indicated, but find a lab with a more reasonable cost without sacrificing quality. I do not use labs that make significant mark ups just because it is an implant. Most reasonable labs are cognizant of the fact that we are all trying to do the best for our patients and make a buck at the same time. Use one of them.

I am a General Dentist,Would like to start placing implantsI took 6 month implant continuum course at NYU, as well as some perio and numerous mini one to three day implant placement,bone grafting courses,and few hands on live surgery, participation courses,However, I feel that i need more training,especially in how to handle potential implant and grafting related complications, I asked Periodontist and Oral Surgeon for mentorig, But even though they did not say it directly, I percieved their attetude was not favorable. Can anyone reccomend a good training /mentoring program in New york area.

I teach implant courses across the country and have placed over 5000 implants so I guess that qualifies me to answer a question about "the long run". I place all the final abutments on simple cases for my refering doctors and the doctors then handle the case like routine crown and bridge. There has been no difference in results in the long run. The key is proper implant placement. We do have to occasionally alter the abutments a bit. Go ahead and do what you propose. By the way, what system do you use?

Dear Dr. F It is not necessary to use custom abutments all the time, stock abutments will work just as well even if the implant placement is not quite perfect. Using stock abutments will save you a significant amount of money. To make your life a lot easier just take a fixture level impression and let a experienced Lab pick the appropriate stock abutment, if a custom abutment is necessary after all, they will let you know. Taking impressions over abutments in the patients mouth is tricky as one contributor already mentioned. Margins often don’t come out as clean. The patient already spent a fair amount of money and time just to get the implant placed, why take the risk of providing a restoration that could have been a lot better if it had been made on the actual abutment on a model. I have restored over 30000 implants (no joke) and I work on cases that were impressed over the abutment in the patients mouth and the fixture level type impression. Let the Lab work with a fixture level impression, this will result hands down in a better restoration and be much more predictable. The Lab Guy

I feel with the various custom abutment offerings today that the prices will decline and new services and companies will emerge enabling doctors to continue to use custom abutments. Outside of atlantis there is zirconiaabutment . com

I feel with the various custom abutment offerings today that the prices will decline and new services and companies will emerge enabling doctors to continue to use custom abutments.

I used this technique for 6 months of preparing the abutment and taking an impression - although cheaper it gave me grey hairs - remakes and a load of headache - in essence although I made more profit (bottom line) I felt my time was wasted - case selection is important for the technique - in the aesthetic zone fixture head impressions are preferable. Times are difficult therefore one way round the problem is to purchase a stock of standard abutments in bulk usually getting a discount and send it with the impressions - hence the lab should only charge for their work. Choose the abutments prior to fixture head impression. But this comes only with experience of doing so.

Upfront disclosure - I am from Glidewell Labs. When we introduced our Inclusive brand of CAD/CAM custom abutments last year, our goal was to provide a custom solution for the price of a stock abutment. For most major implant brands you can have a custom Ti or Zirconia solution for the all-"inclusive" price of $299. That includes all model work, analogs, lab screws, labor, etc. No hidden fees or extra surcharges. Compare that to a Nobel Biocare stock Esthetic Abutment ($170) with, analog ($26), lab screw ($10)and soft tissue model ($40ish) at approximately $246 before the lab adds labor and his mark-up. In most cases you'll pay well over $299 for a stock abutment.

I guess Im missing something here...?? I hardly ever use custom abutments..sure they have a place..particularly in "some " anterior cases ie if the tissue is very deep and I dont want to cement my crowns with loads of subgingival cement I ONLY take fixture level impressions..they are ridiculously easy to do ..most of my staff can put it all together and snap xrays to confirm fit . The lab modifies the abutments on the master model attached to the analog...they dare not charge me for this extra 5 minutes of work (considering the volume they get from me i suppose?) Often I use soft tissue models ..its really not a big deal. Ive been doing this for over 15 years and I teach using only my own work perhaps if you feel the need t do custom every time you ned to look a little closer at the placement in the first place. I use Imtec which I find great.. but so many systems are just as good and even have a very wider array of stock abutments. So to answer your question I see ZERO difference in the longevity of the case

Mr Konnecker How could you have done 30,000 restorations on implants.???? Full time work is 2000 hours a year So you have worked with no holidays for 15 years and you do an implant crown start to finish in an hour. And your lab ONLY does implant crowns Something not right here..or VERY unlikly I thought it was only dentists at convention lunches that brag impossible statistics.

Dear Skeptic I can see where a claim of 30000 restorations seems outrageous.I am a tech for 25 years and I work in a very large lab with a dedicated implant department for more than a decade now. Do I do every step of the production process? No, that would be impossible like you say but I touch every impression and do some parts of the production process of every case that comes in to the lab, start to finish.If you are interested, I'll give you a tour so you can see with your own eyes.

I like doing the preliminary model work myself. I take the fixture level impression and make the models (including soft tissue model) very easily and quickly in about 5 minutes.Then I can determine if a custom abutment is necessary or desirable. I end up restoring the great majority of my cases with prefabricated abutments. It is only when I cannot obtain the desired emergence profile with the prefabricated abutment, (for example, if it would require placement of the cement margin too deep under the tissue)that I use a custom abutment. I don't like preparing abutments in the mouth. I have never seen an abutment prepared in the mouth turn out as good as what you can achieve on your bench or in the laboratory. My two cents.

full disclosure- i run a business selling compatible abutments . i keep running into this with the dentist and now the surgeons who are all faced by a bad economy. pour up your model with the implant replica and soft tissue, buy a few different standard margin collar stock abutments and then place them in the model and adjust accordingly. You cannot get any simpler than that- buy some with more of a tear shape with a broad emergence profile and have an extra implant replica so you can screw the abutment in and prep it down- alot less money than a custom and you have complete control.. The other part of the solution is to buy reasonably priced abutments that enable you to keep your cost down instead of buying the manufactured brands.

Good Points! I usually send my lab several abutments (MIS or AB Dental) These are less than Zimmer etc. I let my lab prep etc. Thus far, I have not needed a super duper custome abutment. When in doubt they prep and I modify in the mouth and impress. This has worked for 20 years.