Dental implant technology has advanced greatly in the last several years. 3D rendering allows periodontists to accomplish a number of things when planning to place an implant for a patient, helping to create a better aesthetic, improved healing, and a better overall outcome. A 3D rendering is also known as CBCT, or cone beam computer tomography. This technology provides an extremely detailed view of the structures inside the mouth. This can help a periodontist visualize nerves surrounding the area where the implant is to be placed and choose the optimal placement for the dental implant hardware. Additionally, the technology allows jawbone density to be measured, indicating whether or not a patient may need bone grafting before the implant can be placed. The 3-D rendering also helps with determining the best implant size and shape to provide the patient with a natural looking permanent tooth with a precise fit.
Many periodontists use a 3D volume rendering technique that allows for the visualization and measurement of a patient’s bone density prior to the implant procedure. Measuring bone density during the initial implant exam is critical, as it determines the next steps of the procedure. If a patient has low bone density, they may need a bone grafting procedure before the actual implant can be placed. Today’s technology allows periodontists to conduct a painless scan, also called CBCT or cone beam computer tomography, to completely map out all the structures in a patient’s mouth. The 3D volume rendering technique is done to enable the doctor to accurately assess bone density without invasive procedures, and a 3D volumetric reconstruction gives the doctor the information needed to begin planning for bone grafting. The doctor can use the reconstruction to determine where the bone graft should be placed and how much bone will be needed.
3D volumetric reconstruction is a newer technology that can be used in a variety of applications, particularly in the medical field. The area of a patient’s body is scanned via CBCT, or cone beam computer tomography, and is a painless imaging procedure. The structures of the body are recreated with 3D imaging, allowing a doctor to completely visualize the area of the patient’s body and even take certain measurements that help better plan for surgical procedures or treatments. One application of 3-D volumetric reconstruction is periodontics. Placing dental implants without good imaging is difficult and reduces the patient’s chances of a good outcome. X-ray technology helps periodontists visualize a patient’s mouth structures to some degree, however, 3D volumetric reconstruction allows for full visibility. This enables a periodontist to measure bone density, assess the location of nerves, and choose the optimal placement for dental implants.
The term “absorbable” refers to the ability of something to be absorbed, particularly by the body. For instance, absorbance units, absorbent pads, absorbable stitches, and absorbable sutures are all designed to absorb or be absorbed. Absorbable products are key in implant dentistry because it’s not often practical or possible to use other types of products. Absorbable sutures, for example, are necessary during the bone grafting process. These sutures do not have to be removed like traditional sutures or stitches once healing has taken place. Over the course of a couple of weeks or so, absorbable stitches will dissolve in the mouth as the gums heal. With bone grafting specifically, the gums are closed over the graft. Absorbable products are necessary to allow the graft to heal without having to open back up the gums to remove sutures. This promotes a healthier healing experience overall.
In the field of implant dentistry, abutment clamp or preload, refers to the force that an implant screw has on the implant and the abutment. This force is linear and holds the components of the abutment connection together. As the abutment screw is tightened, the force used by the periodontist is transferred to both the internal threads of the implant and the threads of the abutment screw. The force “clamps” the abutment to the body of the implant, which is why it is sometimes referred to as “abutment clamp”. Although preload is measured in Newtons, there’s no ideal amount of clamping force used for abutment screws. A periodontist must follow the manufacturer’s recommendation for specific types of screws to determine how much torque to apply and how much preload is needed to clamp the abutment connection together. The force must be measured using special tools to ensure the correct amount is used.
An abutment connection is the connection between the prosthetic screw and the internal implant. An abutment driver, or hand driver, is used to apply force to the prosthetic screw as it is inserted into the internal implant. The force applied to the screw as it is being inserted is called preload, and how much force is used has a significant impact on the success of the finished implant. Too much or too little force can cause an implant to fail, and it is best for a periodontist to follow the manufacturer’s recommendations on each different type of screw because no standard amount of force exists. It differs from implant to implant. Sometimes an abutment holder is used to reduce the risk of dropping abutments into the patient’s mouth during the insertion of the implant. For an implant to be successful, the abutment connection must be strong.
An abutment driver is a screwdriver, much like you might find in a tool chest, although it is much smaller and designed specifically for implant dentistry. They are also called hand drivers, and are textured on the handle to provide a good grip. The tip of the abutment driver is the part of the mechanism that comes into contact with the abutment screw, and often the tip pattern will differ from manufacturer to manufacturer. Some hand drivers can only be used with certain types of abutment screws. During the dental implant procedure, the periodontist will use the abutment driver to screw the prosthetic into the internal implant. How much force applied during this part of the procedure is called preload, and how much preload is used differs between types of hardware. Too much or too little force applied can result in the failure of a dental implant, so using the right abutment driver and using it properly is critical for success.
An abutment holder for dental implants is a device that helps periodontists avoid dropping abutments into a patient’s mouth. Because abutments, abutment screws, and even abutment drivers are all very small, dropping them is a very real issue. It’s important to keep the area as clean as possible and typically the hardware is sterile. Dropping abutments can be costly, however, an abutment holder can help prevent this issue. Additionally, abutment impression coping can help accurately transfer the position of an abutment or implant in relation to the patient’s teeth. An abutment-level impression can accurately record the position of an implant at the abutment-implant interface. When used together, these tools can help periodontists optimize dental implant placement, decrease the chances of dropping abutments during a dental implant procedure, and help improve the patient’s overall outcome.
An abutment impression coping typically comes in two different types — open tray impression coping and closed tray impression coping. Although what abutment impression coping technique is used depends entirely on the periodontists preferences, many periodontists prefer closed tray impression coping versus open tray. This is because with open tray impression coping, the periodontist must be certain they can find and access the impression coping screw to be able to remove the impression. Failure to do so with an open tray may lead to the impression becoming locked in the patient’s mouth. Although a closed tray impression coping does not have this problem and is generally easier to use, open trays are considered to be more accurate, especially in cases of multiple implants that will need to be splinted in patients who are partially or fully without teeth. This accuracy makes open trays preferred by many periodontists.
Abutment mounts for teeth are prefabricated devices that serve as the connectors between the abutments and the replacement bridges, crowns or dentures. An abutment can be a portion of, attached to or built into the top of a dental implant. This section extends through the tissue of the mouth; therefore, the abutment is designed to firmly support and/or retain the patient’s prosthesis. Since there are numerous kinds of abutments available, the dental abutment mounts are typically included in the package of its coordinating abutment.
A dental abutment screw is used to secure the abutment to the dental implant. Although some patients can receive their dental implants during a single session, others will require a second surgical session: These specifics should be taken into consideration when determining which abutment and abutment mount will serve the patient better.
Types of abutments include:
- Angulated abutments/Angled abutments
- Anatomic healing abutments
- Custom abutments
- CAD/CAM abutments
- Healing abutments/Healing cuffs
- Castable abutments
- Nonangulated abutments
- Multi-unit abutments
- Prepable abutments
- Prefabricated abutments
- Transmucosal abutments
- Temporary abutments
- Zirconium dioxide abutments (standard or customized)