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02 Feb 2017

By Dr David Hornbrook

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The introduction to Dr Hornrbook's 'Case report using the 'H' Abutment'

With the introduction of new materials, the trend in dentistry over the
past decade has been to eliminate the use of metal to achieve improved
esthetics as well as conserve tooth structure.

 

Download the entire eBook for free here.

 

This search for the ideal restorative has also influenced the options available for anterior implant restoration. The replacement of an anterior tooth using an implant has been a challenging obstacle for most clinicians. While a metal abutment provides long-term predictability and strength, it can compromise the
esthetic value of the final restoration and limit the restorative options.

 

This is of particular concern if the implant crown is to be matched to
metal-free adjacent restorations such as ceramic veneers or all-ceramic
crowns, which provide translucency that allows the underlying tooth
structure to be seen through the restoration,thus providing a more
realistic and natural appearance. When a metallic abutment is used on an
implant, the restoration must provide the opacity necessary to cover up
the dark color of the abutment, thereby diminishing vitality.


The use of a metal-free abutment such as one made of monolithic
zirconium oxide offers clinicians an improved platform for an overlying
esthetic restoration4 (Figure 1 and Figure 2) in that the abutment can
be dentin-shaded, thus allowing for placement of a more translucent
overlying restoration. Moreover, compromised esthetics due to any
dark grey color emanating from the metal abutment—which can shine
through the gingival tissue, especially in a thin biotype—is eliminated.
However, there has been concern about the fracture load capacity of these
abutments as well as the differences among abutments available from
varying manufacturers.

 

Also, there have been reports from clinicians who have seen fracture of the monolithic zirconium-oxide abutment at the interface between the titanium implant itself and the abutment during torquing of the abutment screw. Others have reported a high incidence of horizontal and vertical fractures either during placement of the screw or during function of the implant body itself due to the thin zirconium-oxide walls of the abutment (Figure 3).


Using a cast gold UCLA-style abutment over a titanium base has been
done successfully for many years.14 The stock abutment is made up
of two separate components—the titanium base with the internal or
external hex and the coronal nylon sleeve, which can be modified and
then cast in gold (Figure 4). One advantage of this type of abutment is
the flexibility it affords the laboratory to custom design an ideal implant
abutment. However, although abutment shape and margin placement are
controllable, the cast gold itself used for the abutment does not allow for
the use of a translucent overlying definitive restoration thereby yielding
less-than-optimal esthetics.

 

Fig 1.png

Fig 1 Monolithic zirconium abutment replacing the maxillary left central incisor.

 

Fig 2.png

Fig 2 Use of an all-ceramic crown over the abutment to provide excellent esthetics and match adjacent all-ceramic restorations.

 

Fig 3.png

Fig 3 Monolithic zirconium abutment.

 

Fig 4.png

Fig 4 UCLA-style abutment showing nylon waxing sleeve over titanium base.

 

 

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