IMPLANT-SUPPORTEDAliaa Mahrouse

FIXED
Assistant lecturer of fixed prosthodontics,
MSA University
PROSTHODONTICS

Dr/Aliaa Mahrouse
Ass.Prof of fixed prosthodontics,
COMPONENTS OF THE IMPLANT SYSTEM
I- Anchorage component:
Implant body.
II- Prosthetic component:
Cover screw.
Healing abutments.
Abutments.
1. IMPLANT BODY (FIXTURE)
It is the component placed within the bone during first-stage
surgery.

E
Fixture

1- Crest module:
Is that portion designed to retain the prosthetic
component in a one piece or two piece implant system.
▪ It also represents the transition zoon from the implant
body design to the transosteal region of the implant at
the crest of the ridge.
▪ Its smooth dimension varies from 0.5 to 5 mm
FUNCTIONS:

a- It has a platform on which the abutment is seated, which

offers physical resistance to axial occlusal loads.

b- An antirational feature is included

on the platform either external hex or internal hex.

c- Designed to reduce the bacterial invasion

Implants also may incorporate an anti-rotational feature
within the design of the fixture body, which may be
either internal or external.
2- BODY:
APICAL DESIGN OF IMPLANT BODY
❖Antirotational feature:

1. Hole or vent.

2. Flat side or grooves.

❖Apical end of each implant

should be flat rather than
pointed
Implant Length Implant Width
❖ Implant length varies from ❖ Range from 3mm to 8mm
5-30mm ❖ When the opposing landmark
❖ Length of the implant in limit the implant length
favorable bone quality and implant diameter is the logical
crown height may range method to increase functional
from 10 to 15mm and surface area
12mm is usually ideal ❖ It should not be wider than
5mm in the ant. and 6mm in
the post

10
 2. Cover screw
• That part which seals the superior part of the implant
during the healing period (osseointegration).
• Low profile to facilitate suturing of the soft tissue
over the implant.
• In 2nd stage, it is unscrewed, removed and replaced by
subsequent components.
cover screw
3.Healing abutments:
• Dome-shaped screws placed after the 2nd stage surgery
before insertion of the prosthesis.
• Length from 2-10 mm and project through soft tissue into
oral cavity.
• They are responsible for smooth healthy healing of the
gingival tissue around the fixture orifice.
• Prevent the growth of tissue over the edge of implant.
THE PERMUCOSAL EXTENSION OR HEALING ABUTMENT
• Termed
a permucosal extension :
because it extends the implant above
the soft tissue and results in the
development of a permucosal seal
around the implant.
• The abutment should be left for 2-3 weeks to insure
epithalization of the gingival tissues.
4. ABUTMENTS

▪ That part resembling the prepared tooth.

▪ These are the intermediate components of the

implant system that will retain the prosthesis and
screw directly into the fixture.

▪ They are 2-10 mm in length.

▪ Their walls are smooth, polished , straight sided.

TERMINOLOGY
✓ Abutment screw
component which secures the dental implant
abutment to the dental implant body
✓ Prosthetic or Attachment screw
component used to secure a fixed dental
prosthesis to the dental implant abutment
In implant systems that incorporate an antirotational
feature, the abutment must have two components
that move independently of each other: One engages
the antirotational feature and the other secures the
abutment within the fixture.

Sleeve in the abutment

to engage into the anti
rotational feature
When an antirotational feature is to be engaged by the abutment,
one component of the abutment (the sleeve) must fit the
hexagon, whereas the other (the screw) independently tightens
the components together.
Classification

According to type of which the prosthesis or

superstructure is retained to the abutment

Screw retained Cement Attachment

retained
 A. Standard or abutment for screw-
retention

The length can be selected to make the restoration margin

either subgingival or supragingival. They are used in case of
accessibility, i.e. enough inter arch space, and if
retrievability is desired.
Advantages: Retrievability of the implant prosthesis.

Disadvantages:
1. Screw loosening (interlocking device or anti rotational
feature).
2. The screw hole should be covered by suitable
restoration that may affect esthetics and be subjected to
wear.
3. Esthetics.
 CONTRAINDICATION
1. Inadequate inter-arch
space, no room for the
regular components.

2. When maximum esthetics is needed. Screw access

is filled with composite resin material.
B. Fixed or abutment for cement
retention
This abutment is much like a conventional crown
preparation (or post and core). It is screwed into the
implants, and has a prepared finish line, to receive a
cemented restoration.
Their walls are smooth, polished and straight sided.
Indications
Inaccessible areas, posterior where accessibility with
screw driver is difficult.

Contraindications
Inadequate inter-arch space (minimum 5-7 mm)of the
abutment should be exposed for retention.
Advantages
1. More easy to use (no need for impression copings, analoges &
screws) as regular crown techniques.
2. Accessability, could be used any where in the oral cavity

Disadvantages
inaccessible
1. Cement failure.
2. Irreversibility in technique are the most
annoying problems so may be
cemented with temporary cement.
 HYGIENIC COVER SCREW

It is placed over the abutment to prevent debris

and calculus from invading the internally
threaded portion of the abutment retention
during prosthesis fabrication between
prosthetic appointments
 Abutments for attachments

✓ Uses an attachment device to retain the prosthesis (O-

ring attachment)
✓ used for removable prosthesis that are implant retained
✓ These may be used for complete dentures and partial
dentures

❖The abutment for cement/ screw/ attachment may be

screwed or cemented into the implant body
According to the material of construction, abutments can
be further classified into:

✓ Titanium abutments
✓ Gold abutments
✓ PEEK abutments
✓ Ceramic abutments
✓ Zirconium abutments
✓ TiN-coated abutments
According to axial relation between abutment and
implant body

1- straight abutment:
-Narrow
-Regular
-Wide
2-Angled abutments:
- It is used when dental implants are not placed parallel to
adjacent teeth to achieve proper restorative contour.

- Angulation range: 10-30

- Advantages:

1) Facilitates paralleling of non aligned implants

Used when implant angles must be corrected for
esthetic or biomechanical reasons.
1. Improve esthetics
2. Correct divergently placed implants
3. Screw access on occlusal surface
4. Facilitate oral hygiene.
5. Avoid anatomic structures.
angulated abutments are not advised for
regular use:
To avoid tipping destructive forces on the implant.

Restoration retention in case of single units.

3-Tapered abutment:
- It is mainly used for esthetic and
functional reasons.

- Transition to restoration is more gradual allowing teeth

with larger cross section to restore with better
emergence profile.

- It improve stability and emergence profile .

- Indication:
1)Large diameter implants.
2) Multiple restorations .
Used with screw retained restorations.
Allow the transition to restoration to be more gradual in larger
teeth, in order to be restored with more physiologic contours
and better emergence profile.

Advantages:
Improved stability & emergence profile compared to standard
abutments.
 Types of abutments

1. A non segmented (1piece) prosthetic component.

2. Segmented : intermediary abutment attaches to the
implant and crown then attaches to the abutment .
Abutments could be classified
according to the design into
F

Inlay cores
Non-segmented or direct abutment:
Used in areas of limited inter-arch distance or areas
where an esthetic outcome is important.
➢ The restoration can be built directly on the implant. so there
is no intervening abutment, e.g. it bypasses the abutment
portion by means of a sleeve waxed directly to the implant.
➢ This direct restoration technique has been called the

UCLA.(Unique castable long abutment).

• Plastic patterns that burned out & cast to be part of the
restoration.
• It is directly attached to the analogue which will be a part of
the prosthesis.
• It is produced in totally castable plastic tube (wax sleeve)
• or a combination of Au alloy base and plastic extension that
provide a mechanical fit of the alloy at implant besides
reducing the cost of the remaining part.
INDICATIONS
1. Limited inter-arch space 3mm is sufficient for this
type of restoration while limited intermediate
abutment need 8 mm.
2. Esthetic areas when soft tissue thickness is less
than 2 mm
3. Less expenses as there are few components and
less time by technician.
Inlay cores:

They are machined in titanium, precious alloys, or porcelain,

using the CAD-CAM system.
HYBRID ABUTMENT (METAL & CERAMIC)
46
 5. IMPRESSION POST (TRANSFER
COPING)

➢ Component used during impression

➢ Transfer of the position of the implant or abutment to a
similar position on the cast.
➢ They may screw into the implant or into the abutment, so they
are subdivided into fixture types and abutment types.
➢ When it is placed in its position, intra-orally impression is
taken.
➢ There are two techniques for taking the impression and so two
designs according to the impression used:

Indirect or standard
Direct or pick-up
transfer coping
transfer coping
 6. LABORATORY ANALOGUE:
• Made to represent the top of the implant fixture
or the abutment in the cast.
IMPLANT IMPRESSION
 Abutment level Implant level
• an impression is taken of • we are taking an
an abutment in place on an impression of just the
implant implant in place
• very similar to conventional • would be like taking an
indirect impression for a
crown and bridgework
post and core
• the impression is exactly as • we will always need a
you would take for a special transfer device
conventional jacket crown
 Implant level
Abutment level
Advantages:
• Advantages:
- Simple technique -Reproducing the intraoral
- Not need special tray relationship of implants
through impression procedures
is the first step in achieving an
accurate, passively fitting
prosthesis.
-.
 • Abutment level Implant level
Disadvantages: -Disadvantages:
• Many Components
- Multiple steps
required
- Heat generation during • Soft tissue impression
abutment reduction may required to record the
affect osseointegration emergence profile of the
- Over reduction may lead to restoration
exposure of the screw
- Reduction of titanium is
difficult
 BONE LEVEL IMPLANT
IMPRESSION CONCEPT
2 impression techniques

Open tray impression Closed tray impression

The choice depends on user preference

and the clinical situation
• Closed tray technique • Open tray technique
1 - Transfer coping are 1- Transfer coping are
attached to implant by screw attached to the implant
2 - Custom tray are loaded with by screws
impression and seated in
patient mouth , remove the 2 - Custom tray is
impression but the transfer fabricated but with an
coping remain screwed to the occlusal window
implants ( not removed inside
impression ). corresponding to the
transfers site .
CLOSED TRAY (INDIRECT) PROCEDURE
OPEN TRAY (DIRECT) PROCEDURE
• Closed tray technique • Open tray technique
3 - The transfer copings are 3 - The transfer should be long
unscrew from the implant , enough to pass occlusally through
replaced in their positions in the window of the custom tray .
the impression , attached to
their analogues , then pour the
impression obtaining a model
containing implant analogues
in similar positions as in
patient mouth .
Closed tray technique: • Open tray technique:
Advantages :
• No additional preparation of Advantages :
tray • More accurate than
• Used in limited mouth indirect technique
opening “can be used in because the relationship
posterior region” between the transfer
• Less time consuming tray coping and the
removed from pt. mouth as impression is not altered
soon as the material sets .
• Closed tray technique: • Open tray technique:

Disadvantages: Disadvantages:
• Can not be used in
• less accurate than
posterior region of the
direct technique
mouth due to
,distortion may occur
inacessibity
during transfer coping
from pt. mouth to the • More time consuming
impression tray seated inside the pt.
mouth for a long time may
• Cannot be used with cause gag reflex to some
different angulated pt.s
abutments because
distortion occur during
removal of the
impression
• Can be classified as fixture analogs and abutment
analogs.
• The advantage of using the implant body analog is
that the abutments can be changed in the laboratory.
But if the clinician is confident that the appropriate
abutment has been selected, using the abutment
impression coping and abutment analog can simplify
the procedure.