implant restorations can be really confusing. Even after restoring implants for 20 years, I still get lost when trying to sort out the components - especially when new products are introduced.

how to choose an implant abutment

Our surgical colleagues are often asked to choose the implant abutment for the restorative dentist and, because they want to keep us happy, they will often do that for us.

My belief is that we are abdicating our responsibility to the patient when we turn over restorative decisions to our surgeons. We are supposed to be the doctor who chooses what goes on top of the implant.

For the sake of this discussion, let’s keep it simple: Do I choose a stock implant abutment or a custom implant abutment?

implant abutment figure 2

​When should you use a stock implant abutment?

Stock implant abutments are manufactured to standard sizes and can be used on both tissue-level and bone-level implants. They are designed to be user-friendly, to make impressions with ease, are the most economical and are typically used for cement-retained restorations.

They can be both straight and angled. They are best used for tissue-level implants that are not in the esthetic zone. The downside of stock implant abutments is that the tissue will conform to the shape of the implant abutment; if used in the esthetic zone, it is very difficult to for your ceramist to achieve optimal emergence contours and to have the tissue support be optimal relative to adjacent teeth.

The other challenge is that the final margin placement of the crown cannot be precisely controlled - it is dependent on the depth of the implant and the height of the abutment.

implant abutment figure 3

​Benefits of using custom implant abutments

On the other hand, custom implant abutments are waxed or milled to a precise position relative to the crest of the tissue; they can be used for either bone-level or tissue-level. There are many options for custom abutments; some are universal based upon a coping that is cemented, others are milled from a titanium or zirconia blank, and some are simple tubes upon which a wax-up is performed.

Custom stock implant abutments, while more expensive, provide much better tissue management and esthetics and, if managed correctly, work well for cemented crowns.

Steve Ratcliff, DDS, MS, Spear Faculty and Contributing Author