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Figure 1. Stock abutments on the implant analogs on the soft-tissue model. |
Figure 2. Abutment Preparation Burs (Kit 4475 [KOMET USA]) with gross reduction carbides on the left, and finishing carbides on the right of the kit. |
In today’s economic environment, laboratory costs can play a factor in acceptance of treatment. A difference of a few hundred dollars may be the decision point for some patients. Additionally, this also plays a factor when dealing with PPO insurance plans that often set the allowable fee at, or below, a UCLA or CAD/CAM abutment laboratory fee as charged to the practitioner. With this in mind, in-office custom abutment fabrication can provide a high-quality abutment at a lower cost, allowing the clinician to work within the patient’s financial and/or insurance boundaries. As a comparison, an in-office custom milled abutment will typically have a cost range between $75 and $100 (depending on the manufacturer). Whereas, the laboratory fee for a UCLA abutment is typically in the $250 range and a CAD/CAM can be more than $325 per abutment.
Before the introduction of the UCLA abutment, the only abutment available was a stock abutment, which either the dental laboratory technician or practitioner would mill; this was done chairside, or on a model creating a customized abutment. Today, this is still offered in some circumstances, and manufacturers have developed what are termed “milling abutments” to allow this to be offered in more situations. A milling abutment is essentially a solid abutment that has bulk added to it. This allows one to change angles as needed when creating a custom abutment, something that may not be possible with a standard stock abutment (Figure 1). Until recently, executing this process in the office was a challenge, as the rotary instruments we had at our disposal to fit our high-speed handpieces did not efficiently cut titanium. Friction-grip carbides in a titanium abutment adjustment kit (Figure 2). Abutments (kit 4475 [KOMET USA]) are now available specifically for shaping (black ring, golden shank) and finishing (red ring) titanium. This can be accomplished either intraorally, or extraorally. The author recommends that, unless minor customization is required, it is better to customize the abutments extraorally. This article will now address the steps for extraoral abutment customization using milling abutments.