What Are Abutments?
The abutment is a metal part that works between the implant and the artificial tooth connecting them in the dental implant treatment process. It is usually made in a dental lab and is generally made from titanium, gold, steel, or zirconia. Sometimes, polyether ether ketone is also used to make abutments.
Abutments are crucial to your dental replacement process. They work as the base for the crowns or false teeth.
Many people seek dental implants for long-term tooth replacement. Dental implants are metal fixtures that imitate tooth roots and are surgically fixed to the jawbone.
A dental implant consists of three parts:
- The implant
- The crown (artificial tooth)
- The abutment
Many dentistry professionals offer two options when planning implant restorations: custom vs. stock abutments.
Custom Abutments: A Brief Overview
A custom abutment is designed to conform to the precise position relative to the tooth’s crown.
It is made by taking an impression of the patient’s mouth.
The impression is then sent to a dental laboratory, where an abutment is created using its profile.
There are several materials to choose from for a custom implant abutment.
Custom zirconia and titanium abutments give greater durability and superior esthetics.
Dentists generally turn to custom abutments for dental implants in the esthetic zone. They can be used for bone-level and tissue-level implants.
5 Distinct Benefits Of Custom Abutments
- Custom implant abutments align with the soft tissue contours of the individual patient.
- They support healthy tissue development without affecting the tissue from adjacent teeth.
- Custom abutments also create a natural emergence profile for a precise fit and natural-looking implant.
- Most custom implant abutments are made from strong custom materials that ensure quality and durability.
- With a custom abutment, you are assured that your implant will provide better long-term tissue management and esthetics to your mouth.
What Are The Drawbacks of Custom Abutments?
A huge disadvantage of custom implant abutments is that they are comparatively more expensive than stock abutments.
Since custom abutments are customized for each patient, it can take longer for the dentist to determine the requirements and shapes of the restoration.
That being said, there is virtually no practical problem with custom implant abutments.
Types of custom abutments
There are two types of custom abutments. They are:
- Gold cast (Or metal cast. Older style)
- CAD/CAM abutments (More recent and in style. Also, CAD/CAM abutments provide statistically superior quality)
What Are Stock Abutments?
Stock implant abutments are manufactured fixtures that come in standard sizes.
Stock abutments are available in straight and angled varieties, making them adaptable to the needs of different patients.
They work best for cement-retained restorations and tissue-level implants not located in the esthetic zone.
They are an economical option available for patients of any background.
Stock Abutments: Advantages
Stock implant abutments are versatile. They can be used for many implant types, like tissue-level and bone-level implants.
Because a stock abutment is pre-fabricated, it is easier for the restorative dentist to make impressions.
It allows for easier installation, lowering the overall cost and time for dental treatment.
Stock Abutments: Drawbacks
Stock implant abutments have many disadvantages.
They are difficult to manage when placed in the esthetic zone because the tissue may not conform to the shape of the abutment.
The final margin placement of the crown cannot be precisely controlled because it relies on the abutment’s height and the implant’s depth.
They can prove challenging for the restorative dentist to achieve optimal emergence contours, resulting in poor esthetics and alignment.
Common complaints regarding stock implant abutments are:
- They may provide an unnatural appearance to the crown
- Maintenance is harder
- Frequent food obstruction
Custom vs. Stock Abutments: Can Abutments Fracture?
Custom or stock: abutments can fracture, complicating your oral health.
According to research, the fracture rate of zirconia abutments may vary from 1.08% to 17.86%. The fracture may vary based on the following:
- Tooth position
- Abutment system
- Implant system
- Implant-abutment connection
The research confirms that most fractures may occur within three years after installing the system. The reasons for the fracture include the following:
- Limited observation time
- Abutment defects
- Stress concentration
- Inappropriate position of the implant
- Overpreparation of the abutment (making it very thin to align it properly with the implant)
- Eating hard food
If your abutments fracture, consult your dentist immediately. The dentist has the tools to remove the abutment fragments without damaging the implant. They will also prepare a new abutment for you.
Custom vs. Stock Abutments: Which Ones Should You Choose?
When Should You Get Custom Abutments?
You may choose custom implant abutments for any dental implant restoration.
A custom implant abutment brings optimal tissue support relative to the neighboring teeth.
Custom implant abutments can also help boost crown retention and ensure optimal emergence contours.
The custom design of the abutment helps it fit seamlessly with natural teeth. It provides better support, hygiene, and aesthetics overall.
Despite being pricier, a custom abutment is a worthwhile investment that can last many years.
When Should You Get Stock Abutments?
Why might a dentist decide on a stock implant abutment?
A stock implant abutment allows dentists to make impressions easily, reducing the time it takes to install the implant abutment.
Stock implant abutments are generally reasonably-priced, making them more accessible for patients of varying financial capacities. If you are tight on budget, you may choose this option.
However, stock abutments are not recommended for implants along the esthetic zone.
The standard sizing lowers the amount of tissue support provided to the neighboring teeth, making it difficult for dentists to exercise precise control over the crown placement.
Moreover, as Dr. Emil LA Svoboda writes, stock abutments are not usually ideal for use with cemented restorations.
According to BioMed Research International, any gap remaining between the implant and the abutment may represent a path for acids, enzymes, bacteria, or their food products that directly affect the mouth tissue, causing inflammation.
Besides, stock abutments may result in poor hygiene and even dental complications in the long run.
Getting a dental implant is a major decision that requires proper planning and execution. According to Implant Dentistry, the quality of the abutments plays a significant role in the long-term functional and esthetic success of the implant-supported dental restoration.
Although stock implant abutments are low-cost and easy to do, they seldom provide adequate support and esthetics.
Therefore, a custom abutment is ideal for a highly functional, aesthetic, and hygienic dental implant.
Custom vs. Stock Abutments: FAQ
Screw loosening in a dental implant system may occur for many reasons, including the following: Excessive fatigue, inappropriate tightening torque, excessive bending, vibration while tightening, forceful fitting to the implant, and inappropriate material of the abutment.
Custom abutments are better than stock abutments. But they can have manufacturing errors. The casting and finishing of abutments require your lab technicians to have excellent technical abilities. They also need access to the latest medical and scientific equipment to create the best-quality abutments for you.
Tallarico, M. et al. Mechanical Outcomes, Microleakage, and Marginal Accuracy at the Implant-Abutment Interface of Original versus Nonoriginal Implant Abutments: A Systematic Review of In Vitro Studies. BioMed Research International. Vol. 2018, Article ID 2958982, 8 pages, 2018.
Svoboda, E. Stock Abutments Cause Problems – Preventable By A Well-Designed Prosthesis Installation System. OralHealth. Accessed on 10 December 2022.
Ganz, S. Implant Abutments: A Comparison of Stock, Custom-Cast, and Computer Milled Restorative Techniques. Implant Dentistry. December 2002 – Volume 11 – Issue 4 – p 387.
Gou, M. et al. Fracture of Zirconia Abutments in Implant Treatments: A Systematic Review. Implant Dentistry: August 2019 – Volume 28 – Issue 4 – p 378-387
Kim, E. et al. Influence of the implant abutment types and the dynamic loading on initial screw loosening. The Journal of Advanced Prosthodontics. 2013 Feb; 5(1): 21–28.
Also from SupreDent: