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Implantology > Abutment Selection > Flashcards

Abutment Selection Flashcards

1
Q

Screw-retained implant restoration

A
  • No abutment
  • Waxed on Gold Adapt UCLA
  • Access hole filled with teflon tape then composite
  • Advantages:
    • Retrievability
    • Better Limited Occlusal Height
    • No Cement
  • Disadvantages:
    • Compromised esthetics
      • composite doesn’t match porcelain
    • Chipped Porcelain
    • Implant Angulation
    • Altered Occlusal Contracts
    • Multi-units=not passive
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2
Q

Cement-retained implant restoration

A
  • Cement Final Restoration
  • Abutment selection depends on:
    • Implant angulation
      • Severe→ Custom abutment
    • Platform depth
      • Deep→ Custom Abutment
    • esthetics
  • Abutment Finish Line ≤ 2 mm subg
  • Advantages:
    • Esthetics
      • no access hole
    • Easier to adjust occlusion
    • Correct Severely Angled Implants
    • Multi Units=Passive Fit
  • Disadvantages:
    • Retrievability
    • Excess cement
    • Not Used with Limited Restorative Space (8mm)
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3
Q

How to avoid cement extrusion

A
  • Abutment finish line ≤ 2 mm sub-g
  • Use radio-opaque cement
  • Clinical & radiographic exam to check bone level or soft tissue inflammation
  • Use rubber dam
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4
Q

Abutment classification:

A
  • Fabrication
  • material
  • Connection
  • Service Period
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5
Q

Abutment Classification: Fabrication

A
  • Prefabrication (Stock)
    • straight or angled
    • Titanium or Zirconia
    • ONLY Cemented crowns
    • Variable cuff height for emergence profile
      • control depth of finish line subg
  • Custom
    • patient specific
    • Angled or deep implants
    • Esthetic Cases→Better emergence profiles
    • Waxed and Cast with Metal:
      • UCLA Gold Adapt:
    • Milled: CAD/CAM
      • Titanium
        • silver or gold
      • Zirconium
        • More esthetic→Thin Biotype
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6
Q

Atlantis

A
  • patient specific abutments for all implant systems
  • Customized emergence profile
    • Double scanning
    • Splinted cases=Parallel Abutments
  • Gemini Abutment
    • Duplicate abutment
    • Titanium or Gold
    • used to finish final restoration in lab
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7
Q

Abutment Classification: Material

A
  • Titanium
    • Stock or Custom
    • Color: Silver or Gold
    • High mechanical properties
      • made from titanium alloy
    • Cost Effective
  • Zirconium
    • Stock or Custom
    • Y-TZP is used
    • Most esthetic:
      • more than one shade
    • Less mechanical properties (Than titanium)
      • made in presintered state→ cannot adjust after sintering
    • Cost effective
  • Casted: (Custom abutment)
    • Anterior Crowns: Type III Gold
      • esthetic
    • Posterior Crowns: Type IV Gold
    • Non-Precious alloys should not be used with implants
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8
Q

Abutment Classification: Connection

A
  • Engaging
    • engages fixture/crown
      • internal or external connection
    • glide path less forgiving
    • Uses:
      • single/splinted cement retained crowns
      • single screw retained crowns
  • Non-engaging
    • No engage
      • No internal/external connection
    • Glide path is more forgiving
    • Uses:
      • ONLY splinted screw retained
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9
Q

Abutment Classification: Service Period

A
  • Healing Abutment:
    • after stage 2 implant surgery (Implant Uncovery)
      • Allows tissue to heal
        • prevents tissue closure
      • able to restore implant
    • taller than mucosa
      • different emergence profiles & heights
    • Color coded diameter
      • Green: 3.5 mm
      • Purple: 4.5 mm
      • Yellow: 5.7 mm
  • Temporary Abutment
    • Supports temporary
      • Titanium Or Plastic (Esthetic cases)
      • Engaging vs non-engaging
  • Definitive Abutment
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10
Q

What are the Factors that Affect Abutment Selection?

A
  • Esthetics→ use a:
    • Cement retained design
    • Gold Type III Cast
    • Gold Plated Titanium or Zirconium Abutment → Thin Gingival Biotype
  • High Mechanical Requirement: for posterior region or FPD, use:
    • Metal (Titanium or Gold Type IV)
  • Implant Angulation
    • use cement design
    • Severe angulation→ Custom abutments to correct
  • Limited Restorative Space:
    • Screw Retained design
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11
Q

Overdentures

A
  • removable denture prosthesis
    • covers & rests on ≥1 natural teeth, roots, or implants
  • Attachments
    • provides the fixation, retention, and stabilize the prosthesis
    • on teeth, roots or implants
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12
Q

Tooth Supported Overdenture: Advantages vs disadvantages

A
  • Advantages:
    • Preserve:
      • alveolar ridge height
      • Proprioception (PDL mechanoreceptors)
    • Improves:
      • retention & stability with attachments
      • Denture support (vertical stops)
    • Less psych trauma-not all teeth are lost
    • Convertibility→switch to complete denture if teeth are extracted
  • Disadvantages:
    • Exposed Dentin→Increased risk for caries
    • RCT therapy
      • potential coronal leakage→ RCT failure
    • Canines→ Denture Flange irritates mucosa
    • Possible cementum failure
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13
Q

Tooth Supported Overdenture: Indications vs contraindications

A
  • Indications:
    • poor candidates for surgery
      • radiation therapy
      • bisphosphonates
    • Financial constraints
      • can’t afford implants
  • Contraindications:
    • Tissue undercuts
    • Poor Manual Dexterity
    • No distribution of abutment teeth→poor prognosis
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14
Q

Tooth Supported Overdenture: Abutment Teeth

A
  • Adequate
    • Perio health
    • endo therapy
  • 8-10 mm of restorative space
    • < 8mm →break denture
  • ≥ 5mm of root in bone
  • Location:
    • Anterior Mandible
      • Alveolar ridge most vulnerable to resorption
      • Canines or Premolars→ reduce adverse forces
    • At least one tooth per quadrant
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15
Q

Tooth Supported Overdenture: Options

A
  • Tooth Supported Overdenture with:
    • no attachment
      • amalgam plug
      • gold casting
    • attachment
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16
Q

Tooth Supported Overdenture with no attachment

A
  • Provide Support Only
  • Dome shaped abutment
  • Amalgam Plug
    • Direct Restoration→ Amalgam or Composite
      • requires 1mm supracrestal tooth
      • only provides coronal seal (access hole)
        • does not cover dentin
  • Gold Coping
    • Indirect Restoration
      • Tooth at Crestal ridge
      • Coronal & dentin coverage
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17
Q

Tooth Supported Overdenture with attachment

A
  • Provide Retention & support
  • Direct or Indirect Restoration
    • Direct:
      • root is straight or 10-20° divergent
    • Indirect:
      • Root > 20° divergent
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18
Q

Implant Supported Overdenture: Advantages vs Disadvantages

A
  • Advantages:
    • Preserve alveolar ridge height
    • Improves
      • retention & stability
      • support to denture (Vertical stop)
    • No dentin exposure, caries, decay, endo complications
    • Control implant locations
    • Less maintenance
  • Disadvantages
    • requires sufficient bone volume for implant placement
    • Financial constraints
    • No proprioception (No PDL mechanoreceptors)
    • Can’t undergo implant surgery (medically compromised)
    • Maxilla=4 implants
      • compromise peripheral seal<4
      • Canine
    • Mandible= 2 implants
      • canine & 2nd premolar
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19
Q

What are the different types of Attachment Systems used in over dentures?

A
  • Both used in Implant or tooth supported overdenture
  • Stud Attachment:
    • locator=most common
      • consists of 2 parts (male & female)
        • 1 attached to abutment
        • 1 attached to denture base
  • Bar Attachment:
    • Physical barrier goes b/w implants or natural teeth
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20
Q

Stud attachment Advantages vs disadvantages

A
  • Advantages:
    • Less restorative space needed
    • easier to clean and replace
    • auto aligns when placed
  • Disadvantages:
    • less stable
    • Limited implant angle correction
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21
Q

Locator Abutment/Attachment

A
  • most common stud attachment
  • adjust unparalleled implants
    • Regular vs extended range males:
      • regular:
        • if abutment is < 20° off
      • Extended range:
        • if abutment is > 20-40° off
  • multiple cuff heights (1-5mm)
    • Use thickest tissue level
    • allows retention groove to be at surpragingival height
22
Q

What are the two methods to attach the metal housing to the denture

A
  • Direct Method
    • Place abutment
    • place metal housing
    • Try on denture & modify denture
  • Indirect Method:
    • take abutment height
    • registration in the impression
23
Q

What are the different parts of the Locator?

A
  • metal housing
    • holds long insert
    • gives force
  • Nylon insert
    • attaches denture base to abutment
24
Q

Bar Attachment: Advantages vs disadvantages

A
  • Advantages:
    • increased stability
    • Increased stress distribution
    • Fixes poorly placed implants
  • Disadvantages:
    • Hard to clean
    • More expensive
    • requires 13mm of restorative space
25
Q

Implant Provisionalization: Advantages

A
  • restore esthetics & function
  • extended period of use (Bone graft)
  • patient exerpience prosthesis before final restoration (expensive)
26
Q

What are the provisionalization options before implant healing?

A
  • Fixed Provisionals
    • Bonded bridge
      • “Ribbond or Everstick”
    • Temporary Fixed Bridge
    • Immediate Implant provisionalization
    • Temporary Implant retained provisional
  • Removable Provisionals:
    • Removable Partial Denture (RPD Flipper)
    • Complete denture
    • Essix retainer
27
Q

Fixed Provisionals vs Removable Provisionals

A
  • Fixed:
    • more comfortable
    • well tolerated
    • show how final prosthesis will look and feel
    • less bulky
  • Removable
    • Remove at night
    • Bulkier
28
Q

Bonded bridge:

General Info

Advantages vs disadvantages

A
  • Framework=Ribbond (Fiberglass) or Everstick
  • Advantages:
    • No transmucosal loading
  • Disadvantages:
    • requires special materials
    • Can’t replace >1 anterior tooth
    • Weak bond in:
      • wear cases→ due to lack of enamel
      • poor isolation
    • Can’t use if:
      • Deep Bite
      • crowned adjacent teeth
29
Q

Temporary Fixed Bridge:

General Info

Advantages vs disadvantages

A
  • aka Tooth Supported Temporary Bridge
  • Advantages:
    • No Transmucosal loading
    • More resistant to dislodgment
  • Disadvantages
    • Have to prep adjacent teeth
    • Prepped teeth cannot be finalized until the implant is ready to be restored
30
Q

Immediate Implant Provisionalization:

General Info

Advantages vs disadvantages

A
  • Provisional placed immediately after implant placement
    • take tooth and hollow out→use as shell
  • Keep out of occlusion
  • can’t use w/parafunctional habits
31
Q

Temporary Implant retained provisional:

General Info

Advantages vs disadvantages

A
  • Fixed Provisional
    • Mini Implants=Temporary Implants
      • holds temporary prosthesis
      • don’t osseointegrate→ Easily Removed
  • Advantages:
    • takes the load off definitive implants
  • Disadvantages:
    • added expense
    • High stress area=Fracture
32
Q

Removable Partial or Complete Denture

General Info

Advantages vs disadvantages

A
  • Removable Provisoinal
    • tissue supported
  • Advantages:
    • cheap
    • convert to fixed temporary after implants are healed
    • if satisfactory=index for final prosthesis
  • Disadvantages:
    • Transmucosal loading
    • Bulky
    • Psychological trauma
33
Q

Essix Retainer:

General Info

Advantages vs disadvantages

A
  • teeth supported
    • No Transmucosal Loading
  • Disadvantages:
    • Breaks easily
    • Altered speech at beginning
    • Don’t use when eating
34
Q

What are the provisionals used after implant Healing?

A
  • Cement Retained Provisional
  • Screw Retained Provisional
35
Q

Cement Retained Provisonal:

General Info

Advantages vs disadvantages

A
  • Temporary Abutment
  • Plastic Gasket “Coping”
  • Advantages:
    • More esthetic
  • Disadvantage:
    • can’t use with Short Abutment
      • limited inter arch space
    • Excess cement in sulcus
36
Q

Screw retained Provisional:

General Info

Advantages vs disadvantages

A
  • No Abutment
  • Advantages:
    • Better for Limited Interarch space
  • Disadvantages:
    • No Angled Implants=Facial access hole
37
Q

Implants: General Impression info

A
  • after osteointegration
  • record all dimensions accurately
  • easier than natural teeth
    • but Less forgiving (No PDL)
38
Q

Implant body

A
  • Aka Implant fixture screw or cylinder
  • part of implant in bone
39
Q

Impression Coping

A
  • transfer implant position to cast
  • used during impression
40
Q

Impression Analog

A
  • Implant replica
    • used on the cast
41
Q

Tight Contacts: (b/w implant & teeth)

A
  • Increase stress
    • No PDL→ Never neutralized
  • prevent complete seating of restoration
  • Complications:
    • biological→ Bone Loss
    • Mechanical→ Screw Loosening
42
Q

What are the different types of impression techniques for implants?

A
  • Implant Level (deeper)
    • High Esthetic cases
      • Anterior Implants
    • Recreates gingival tissues
      • uses resin
    • Types:
      • Open Tray (Direct Coping Transfer)
        • Splinted vs Non-Splinted
      • Closed Tray (Indirect Coping Transfer)
      • Customized Impression transfer technique
  • Abutment Level (shallower)
    • use w/Solid Abutments
      • final abutment delivered and temporized
      • allows for healing to go ahead and start
    • Impression coping “clicks” onto abutment
    • Types:
      • Direct
      • Indirect
  • Digital Impression
43
Q

Open Tray Impressure

A
  • Implant level impression (Deeper)
  • Direct Coping Transfer
    • pick-up impression
  • Coping:
    • long retaining screw that goes through tray
    • unscrew when impression material set
  • Limits:
    • hard to seat inside mouth so that screw goes through hole
    • Posterior region (more difficult)
  • Non-Splinted:
    • Copings: Not Connected
    • Limits:
      • Movement→inaccurate relationship of implants
  • Splinted:
    • Copings: Connected w/resin or composite
    • Limits:
      • time consuming
      • technique sensitive
        • Material shrinkage
44
Q

Closed Tray Impressions

A
  • Implant Level impressoins (Deeper)
  • Indirect Coping Transfer
  • Limits:
    • Transfer process:
      • incorrect orientation
      • inaccuracies
45
Q

Custom Impression

A
  • Implant level impression
  • Modified open tray impression
  • Esthetic Zone
    • better emergence profile & soft tissue contours
  • Anterior Teeth emergence profile
    • supports soft tissue→ Superior esthetics
  • Rapid Tissue collapse after temporary crown is removed
46
Q

Emergence Profile

A
  • transition from circular implant diameter to restoration contours
    • “Running Room”
47
Q

Custom Impression Transfer Technique

A
  1. Unscrew Temporary Restoration
  2. Screw Temp on analog
  3. Place Temp/Analog in plastic cup filled with Bite Registration
  4. Remove temporary (analog stays in bite registration)
  5. Connect Impression Coping to Analog
    1. fill gap b/w bite registration and coping w/autopolymerizing acrylic resin
  6. unscrew customized impressions coping from analog
  7. Seat Impression coping on implant intra-orally
  8. Take impression
48
Q

Abutment Level Impression

A
  • Closed Tray Impression Technique
  • use with Solid abutments
  • Final abutment is delivered & temporized
    • allows healing to go ahead and start
  • Impression coping “clicks” onto abutment
  • Limits:
    • Prefab abutments can’t be used with:
      • severe implant angulation
      • Deep implant platforms
  • Direct vs Indirect
49
Q

Digital Impressions

A
  • 2004
    • coded healing abutment
    • provides 3D info on implant location to:
      • adjacent teeth
      • opposing dentition
      • soft tissue
  • Scan Body
50
Q

Digital Impression: Scan Body

A
  • translates implant position to digital file
  • same fxn as impression coping
  • require intraoral scanner (IOS) to collect data (point clouds=3D coordinates)

Implantology (15 decks)

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