Abutment Selection

Why technicians should carefully consider their choice of implant abutment.

There is much to learn in implant dentistry, particularly when working with multiple systems and all their options for hardware components. The very best guarantee of trouble-free restoration is a thorough knowledge of the system and its requirements and protocols, and applying them to your work. Unfortunately there is a growing trend within our world for using third party CADCAM solutions or copy components, which are not in any way researched or independently tested.

Today as registrants of the GDC and the requirement for professional standards, many technicians and clinicians are completely discounting considerations such as patient interest and disclosure and instead are following the prices guide or the persuasive marketing hype when it comes to abutment selection.

Original Components

Abutment Selection torque values after cyclic loading

While it may appear convenient or money saving to use third party component options, the integrity of fit and the load bearing potential has been shown, in several studies, to be lamentably poor. In a published study comparing three copycat systems against an original abutment, two of the copies fractured during the loading tests and all three copies fell very short indeed of a trouble-free expectation[1]. Another study recommended that copy abutments should not be considered as they seem not to perform as the original abutment to original implant comparison[2]. Initially, of course, all of the copies appeared to be very similar to the original and to the naked eye seemed good enough to use.

Figure 1 illustrates screw-loosening with interchangeable abutments in internally connected implants after cyclic loading[3].

The abutments were connected to the implants at 35 Ncm before loading. The original Straumann connection shows the highest removal torque* after cyclic loading reflecting the smallest effect of screw loosening. *Results for Straumann abutments on Straumann implants are statistically different from those with non-original parts.
Although different abutments are interchangeable with each other, they possess different chemical compositions and physical characteristics. The use of an abutment and implant manufactured by the same company is recommended to prevent the loosening of the abutment screw.

The trouble is that without scientific testing equipment the clinician or technician cannot possibly know the validity of the copy systems and as such should, in my opinion, not even think of using them. The main arguments are either cost savings or convenience, and despite the fact that any patient guarantee is immediately negated, many continue to ignore the patients’ interests.

[1] Seong Kyun Kim et. Al. Inter. J of Maxillofacial Implants 2012:27:42:47.

[2] Michel Gigande et.al.Clinical Implant Dentistry Relat. Res. E

[3] Kim et al. Int J Oral Maxillofac Implants 2012; 27:42–47.


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