Customized healing abutments are utilized in implant surgery to preserve hard and soft tissue around dental implant[1] and also allows us to obtain the emergence profile necessary for prosthetic reconstruction[2].
Master in Implantology and Bone Regeneration
Zerodonto supports a hybrid Postgraduate Master Course in Implantology and Bone Regeneration in agreement with the Università Cattolica del Sacro Cuore in Rome at the Gemelli Hospital.
At a 30-year-old male patient, lower left first molar was to be extracted due to root caries. The CBCT was performed at the patient; an intraoral scan was taken. Data in DICOM and STL formats were uploaded to a surgical planning software coDiagnostiX where the datasets were matched. The occlusal space for the crown was very limited, so it was extremely important to position the implant correctly to have adequate space for prosthetic component, biological height, and the crown itself. The 4 mm distance was calculated apically to cementoenamel junction to position the implant platform. A Straumann BLX implant was chosen for its good performance in immediate implant placement. The sleeve was positioned, and as it was interfering with the tooth, the tooth segmentation was performed in both datasets. The surgical template was then designed, and 3D printed.
Tooth segmentation
Surgical template design
The connection with dental technician software Cares Visual was established, where the implant was visualized, and the customized healing abutment was designed following the tooth anatomy. It was also possible to upload the abutment design back to the surgical software for surgeon’s approval. The healing abutment was then milled of Zr02, cemented on the Variobase and polished for better soft tissue adhesion. This material was chosen for its better biocompatibility comparing to usually utilized PMMA.
Individual healing abutment design in dental technician software
Individual healing abutment uploaded to the surgical planning software. Limited space for the restoration can be observed.
In the day of the surgery the tooth was extracted, surgical template positioned, implant site preparation performed utilizing the guided surgery kit and following the surgical protocol generated by the software. The implant was positioned by matching the rotation markers on the surgical template and insertion tool, thus obtaining the planned position of the implant itself and the customized healing abutment.
After the healing period, the impression was taken, and a screw retained Zr02 crown on Variobase was designed and fabricated.
Final crown
2 years follow up
2 years follow up
In this patient due accurate implant planning, it was possible to achieve a correct dimensional final restoration.
- Chokaree P, Poovarodom P, Chaijareenont P, Yavirach A, Rungsiyakull P. Biomaterials and Clinical Applications of Customized Healing Abutment-A Narrative Review. J Funct Biomater. 2022;13(4).
- Teslak M, Ziemlewski A, Foltyn I, Ordyniec-Kwasnica I, Drogoszewska B. Development of Custom Anatomic Healing Abutment Based on Cone-Beam Computer Tomography Measurement on Human Teeth Cross-Section. Materials (Basel). 2021;14(16).
