Healing Abutment Rescue (Part 2)

9 Aug 2017 - 17535

There are several circumstances in which we cannot dispose of specific prosthetic components to solve rehabilitation cases with dental implants, or that the components that we have at our disposal do not fit our needs to obtain an optimal emergence profile. Some of these situations among other could be:

– In the exposure implant surgery stage we do not have the specific healing abutment which corresponds to the connection of the implant.

– We have the corresponding healing abutment but the diameter or height is less than needed.

– When we want to obtain a certain emergency profile that will fit the tooth to be restored and how to develop the personalized healing abutments.

We present here several options to solve these problems with the aid of adhesion and composite resins.

Part 2

There are several situations when the commercial healing abutments will not fit the emergency profile that we require to obtain a harmonic restoration. The external contours of these elements might be non ideal, in perimeter or in height. An adequate handling of soft tissues around the implant, before, during and after restorative procedures will enormously increase the chances of having a good restoration.

In this second article, we will show how, with an adhesive technique, we can modify the standard healing abutments and make them adequate to the best fitting silhouette for our needs.

 

Fig. 1

After 4 months of surgical placement of the implant, we remove the temporary crown of the neighbor tooth to see the situation of the soft tissues.

Fig. 2

We proceed to the second surgical stage, doing a small incision in H shape, more towards the palatal area, in order to remove the closing screw and place the healing cap; displacing a small amount of gingival to the buccal area.

Fig. 3

A 3 mm diameter and  3mm height healing abutment is placed. BioHorizons-Birmingham-USA.

Fig. 4

Once the healing is placed, we can appreciate a slight ischemia around the area.

Fig. 5

This ischemia should be transitory. In order to avoid damage and to let the soft tissue adapt to the shape of the healing abutment, the insertion should be done slowly and with resting times to achieve the goal of setting the abutment without harming the tissues.

Fig. 6

After 2 weeks of the second surgery, we will remove the healing abutment to start the prosthetic phase.

Fig. 7

When trying to insert the transfer abutments, we can find a narrow gingival access (as seen in the image).

Fig. 8

 It is imperative to modify the emergency profile, so we will proceed to transform the external anatomy of the healing abutment. First, by doing a 50 micron Aluminium Oxide sand-blasting of the healing abutment to achieve micro retentions for the resin.

Fig. 9

Once the healing abutment is clean and dry, we will apply a layer of hydrophobic resin and the the flowable resin. We will polymerize thoroughly.

Fig. 10

With stones and rubber tip the final anatomy is sculpted.

Fig. 11

With brushes and polishing paste the surface is polished.

Fig. 12

Once the customization is done, we sterilize it to insert it back over the implant.

Fig. 13

We can observe the augmentation of the healing abutment creating a more convenient emergence profile, more similar to a natural tooth.

Fig. 14

In this occlusal view we can appreciate a transitory peripheral ischemia around the healing abutment. If this ischemia will not disappear, the modification has to be thinned to avoid problems.

Fig. 15

From the pictures we can appreciate the appearance of the gum before and after the healing cap placement. We can see a widening in the gingival access, facilitating the insertion of transfer abutments and eventually the prothesis.

Fig. 16

Once the prosthetic work is finished, we can observe how the soft tissues are integrating to the crown.

 

Conclusions

The prefabricated healing abutments are provided by the implant manufacturer to fit their own implants. Companies have improved the design through the years, with better contours, better edges and some times the copy of the transfer abutment for a better position of the gingival margins. These designs require less preparation time in the laboratory and chair side.
When the volume of the metal is not enough to define the correct gingival profile, the connection of the permanent abutment to the anti-rotational, or the emergence profile because of their differences in height, or the thickness of the soft tissues, where the prefabricated abutments offer less flexibility.
Nevertheless, by modifying with composite resins and bonding techniques these profiles, the eventual clinical situations can improve importantly.

Bibliography

1. Roberto Chaves. Restauraciones Protéticas Adhesivas. Ediciones Advance, 1991.

2. U. Bragger, L.J.A. Heitz-Mayfield. Biological and hardware complications in Implant dentistry. Editorial Quintessence, 2015.

3. Pedro D. Gazzotti. La rehabilitación Implanto Protésica. Editorial Porvidence, 2008.

4. Branemark, Zarb, Albrekstsson. Tissue Integrated Prostheses. Quintessence Books, 1985.

5. Patrick Palacci. Esthetic Implant Dentistry, Cap 8 159/202. Quintessence Books, 2001.

6. Carl E. Misch. Dental Implant Prosthetics Editorial Elsevier, 2006