On the subject of dental implants, most people are familiar with the bridge or crown and the implant itself. An often overlooked, and less frequently discussed, part of the ensemble is the abutment.
Usually made of zirconia, titanium, stainless steel, or gold, dental implant abutments are small objects that connect the dental implants to the crown or other restoration. In addition to serving as a connection, the abutment helps shape the gums around the dental restoration in a healthy and aesthetically pleasing way. Choice of abutment material is important as it affects both strength and aesthetics. Therefore, careful consideration should be taken when determining the correct abutment for the procedure.
How Are Abutments Placed?
- Expose the Implant: Abutments may be placed in conjunction with the implant (1-stage surgery) or during a subsequent surgical procedure post-implant placement (2-stage surgery). If a second surgery is needed to place abutments, a small incision is made to the gum tissue to expose the implant.
- Place Healing Abutments: Often a temporary healing abutment is secured to the implant while the gums heal. Dentists often use healing abutments (healing cuffs or caps) following implant surgery to promote gum development and cover the hollow centers of the dental implants. While this abutment will not attach to the dental implant it serves a crucial role in the healing process which could take several months.
- Place Final Abutments: Once the gums have sufficiently healed, and impression is taken and the final abutment is placed. Final abutments serve as the connectors that attach the prosthesis to the implants. The dentist could opt to use a custom-made abutment designed to match the specific anatomy of the patient. For areas of the mouth that are visible during smiling, this custom-made design is especially important in ensuring a seamless transition between the gums and the crown.
The dentist will also have to decide between cementing the crown directly to the abutment or screwing it on. Both methods have their pros and cons. Cement retention provides maximum aesthetics, but excess cement has the potential to cause gum inflammation and can make any repairs difficult and costly should complications arise.
Screw retention provides the luxury of retrievability. Should any complications arise with the restoration, the screw retained restoration can be easily removed allowing for repairs and examination of the soft tissue and implant. A perceived disadvantage of screw retention is concern regarding the visibility of the access channel.
Generally, four to six weeks will be needed for the gums to heal around the abutments. Patients will be given instructions for cleaning around the abutments as well as the types of foods they can eat. Following the surgeon’s advice will help promote healing and prevent any infections from developing.
Should the patient experience any of the following while healing, they should consult their surgeon right away:
- Bleeding that will not stop
- Pain in the mouth, jaw, or sinuses that does not respond to prescribed medication
- A fever over 100.4º F
- A abutment that feels or becomes loose