Today we have available a wider selection of custom components that allow us maximum flexibility in aesthetic situations regardless of implant manufacturer. CAD/CAM technology is reinventing the way we customize implant treatments.  Procera CADDesign lets us customize abutments to match the needs of each individual patient (Figure 20). These abutments are available for both the Branemark and Replace Select implant lines and now can be made from titanium or sintered Zirconia. This technology allows us to create custom abutments to practically any angle, taper, finish line, height and width to create the most natural form and emergence profile.  Providing the benefits of superior strength with a white tooth shade emerging from the gingiva, makes these custom Zirconia abutments an ideal choice for anterior reconstructions. Procera is not alone in the CAD/CAM field. Other implant manufactures such as 3I (Implant Innovations) are now utilizing computer technology to create their own custom abutments through their Encode Custom Abutment Line (Figure 21) to enhance their existing CAD/CAM restorations such as CamStructure Milled Titanium Bars.


In a situation where custom all-Zirconia abutments are not available, we still have other options that work equally well.  They provide great strength, with the ability for more natural emergence profiles without the graying of the gums.  We are able to take the gold based UCLA Abutments, that most implant companies provide, cast them to their ideal shape and contour for our situation, and then create the labial margin area by baking porcelain directly onto them (Figures 22 &23).  With this technique we get the strength and fit of a machined metal abutment with the aesthetics of an all-ceramic abutment avoiding the unaesthetic graying of the gingival tissue (Figures 24 &25).

 
Manufacturers of quality implant lines not only spend vast amounts of time exploring implant fixture and restorative component designs; they have also advanced retentive screw technologies. Predetermining the correct amount of torque for the size, shape and materials that screws are made from, has all but eliminated the results of screw loosening or ‘backing out” due to micro-vibrations (Figure 26).  Screws coated in gold or made from select alloys, when torqued using the correct amount of force, form what equates to a “cold weld”, locking the screw into position (Figure 27).

Using manufacturers recommended components of implant fixtures, restorative parts and screws also ensures you are protected with whatever warranties the implant companies provide. As the old saying goes, “The sweetness of the savings is long gone when the bitterness of a failure is left behind.”
Consider now the many options you have available the next time you are faced with an aesthetics situation involving implants. At times, the restorative options can seem overwhelming. By applying a more simplified approach to restorations and prosthetics, combining them with accurate mounted and equilibrated models, implant dentistry can be both enjoyable and profitable.
With greater educational opportunities available to dentists, laboratory technicians and to the general public at large, dental implants are quickly becoming one of the fastest growing areas of dentistry.  The concept of conservative dentistry has definitely played a major role in the popularity of dental implants, especially when only replacing a single missing tooth. This combined with the maturing of the baby boomer generation and their relentless pursuit of youth and the ability to enjoy life has provided for an environment with many positive attributes.
The time has now come to explore and expand this area of dentistry.  Find a mentor, or someone whom you can rely upon, and build your implant team of professionals. Start your learning today.  The rewards and benefits to your practice will most certainly outweigh any costs.
I would like to graciously thank Dr. Stephen Abrams, Dr. Paul Jesin, Dr. Steven Rosenblat, and Dr. Michael Weinberg for providing the clinical photos and guidance for this article.  They have all been inspirational as mentors in our continued pursuit of excellence in implant dentistry.
Ron Klausz, R.D.T. is owner of Klausz Dental Laboratories, located in Toronto, Ontario.  A second generation registered dental technologist, he has chosen to follow in his father’s footsteps.  He keeps with the family traditions of producing advanced, high quality restorations and appliances while developing unique client and patient care services.  He has modernized a company, whose focus is still based on fulfilling client needs.  “Working harder and smarter for your practice!” is their credo.


The author wishes to express that he has no financial interest in any of the companies or products mentioned in this article. However, Klausz Dental Laboratories is certified as a Nobel Aesthetic Laboratory, a Zimmer Preferred Laboratory Member and a 3I Certified Laboratory.

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