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Case Study
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Aesthetic Treatment in Implant-Supported Restorations: Transitional Custom Abutments

Learning Objectives:

This study discusses the rationale, indications, and technical aspects related to the clinical application of transitional custom abutments. Upon reviewing this study, the readers should:

  • Possess an increased familiarity with the technical protocol required to use transitional custom abutments clinically
  • Demonstrate improved awareness of the benefits afforded by this restorative technique.

 

Traditionally, limitations at the restorative/implant connection have posed obstacles in the achievement of superior treatment outcomes with osseointegrated implants. Complications often resulted in aberrant contours that were unaesthetic and difficult to maintain--particularly in the management of compromised fixture placement. Several prosthetic components have been developed in an effort to optimize the emergence profile of implant-supported restorations by improving the relationships at the tissue-restorative interface.

The development of alternative implant diameters has allowed individualized fixture selection to specifically match the cervical widths of the replaced teeth. In addition, various restorative components have been designed to guide the healing of the supraimplant soft tissue contours. Despite their efficacy, however, it is impossible for any prefabricated abutment system to compensate for the infinite variations in gingival topography that may be encountered intraorally. 

The use of customized abutments has been suggested as an alternative to circumvent the limitations of prefabricated components. Although this technique represents a significant improvement, the design of the custom abutment remains confined within the supraimplant soft tissue contours generated through the use of prefabricated healing abutments and subsequently transferred with standard impression posts. This article introduces the transitional custom abutment technique as a prosthetic adjunct to increase restorative flexibility and improve emergence profiles--particularly in the presence of compromised fixture placement, angulation, or selection. 

The term transitional custom abutment accurately describes the progressive contour modifications and gingival remodeling required to achieve an aesthetic emergence profile. The aforementioned technique is not limited to the development of an adequate emergence profile, but may also include aesthetic enhancements to the tissue-restorative interface, eg, control of gingival margin position, creation of interdental papillae, and camouflage of compromised mesiodistal as well as buccolingual implant placement. Adequate position and proper fixture selection are essential in achieving predictable implant-supported restorations. The utilization of transitional custom abutments further enhances restorative flexibility while allowing the optimization of emergence profiles in situations that involve compromised fixture position, angulation, and selection. The technique's versatility allows its application in simple as well as extensive restorations. 

 

*Clinical Assistant Professor, Postdoctoral Periodontal Prosthesis, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania; private practice, Bryn Mawr, Pennsylvania

  

Related Reading:

  1. Zamzock J. Avoiding ridge laps through nonsurgical soft tissue sculpting on implant restorations. J Esthet Dent 1996;5:222-228.
  2. Weisgold A, Arnoux JP, Lu J. Single-tooth anterior implant: A word of caution. J Esthet Dent 1997;9(5):225-233.
  3. Lewis S, Avera S, Engleman M, Beumer J. The restoration of improperly inclined osseointegrated implants. Int J Oral Maxillofac Impl 1989;4(2):147-152.
  4. Lewis S. Anterior single-tooth implant restorations. Int J Periodont Rest Dent 1995;15:30-41.
  5. Daftary F. Natural esthetics with implant prostheses. J Esthet Dent 1995;7(1):9-17.
  6. Jansen CE, Weisgold A. Presurgical treatment planning for the anterior single tooth implant restoration. Compend Cont Educ Dent 1995;16(8):746-762.
  7. Anitua E. In: Implant Surgery and Prosthesis: A New Perspective. Vitoria, Spain: Puesta Al Dia Publicaciones, S.L.; 1998.
  8. Lazzara R. Criteria for implant selection: Surgical and prosthetic considerations. Pract Periodont Aesthet Dent 1994;6(9):55-62.
  9. Jansen CE. Guided soft tissue healing in implant dentistry. Calif Dent Assoc J 1995;23(3):57-64.
  10. Daftary F. The Bio-Esthetic abutment system: An evolution in implant prosthetics. Int J Dent Symp 1995;3:10-15.
  11. Salinas TJ, Sadan A. Establishing soft tissue integration with natural tooth-shaped abutments. Pract Periodont Aesthet Dent 1998;10(1):35-42.
  12. Pissis P. Emergence profile considerations of implant abutments. Pract Periodont Aesthet Dent 1994;6(7):69-78.
  13. Rieder C. Customized implant abutment copings to achieve biologic, mechanical and esthetic objectives. Int J Periodont Rest Dent 1996;16(1):21-29.
  14. Chiche FA, Leriche MA. Multidisciplinary implant dentistry for improved aesthetics and function. Pract Periodont Aesthet Dent 1998;10(2):177-186.
  15. Neale L, Chee W. Use of provisionals to determine the contour of definitive implant restorations. J Prosthet Dent 1994;1:364-368.
  16. Chee W, Donovan T. Use of provisional restorations to enhance soft-tissue contours for implant restorations. Compend Cont Educ Dent 1998;19(5):481-489.
  17. Salama H, Salama M, Kelly J. The orthodontic-periodontal connection in implant site development. Pract Periodont Aesthet Dent 1996; 8(9):923-932.
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