Advantages of CAD/CAM Custom Abutments in Implant Dentistry

The use of CAD/CAM (computer-aided design/computer-aided manufacturing) technology to design and manufacture custom implant abutments is a highly predictable and reliable fabrication process; demonstrating survival rates comparable to conventionally fabricated abutments². The latest generation of CAD/CAM techniques allows the “clinician or technician to fully customize the abutment contour to match carefully the clinical situation after tissue customization with provisional restorations”¹.

Benefits of CAD/CAM Custom abutments

·         Precisely configures abutment for ideal anatomic contours¹

·         Optimal design for esthetic emergence profile¹

·         Highly predictable manufacturing process²

·         Availability of angulation correction¹    

·         100% survival rates reported up to a 6-year period²

·         No technical complications reported up to a 6-year period²

·         Cheaper than gold cast abutments¹

Over the last 10 years, dental CAD/CAM digital systems have been gaining increased use in implant dentistry because of the accurate and calculable nature of CAD/CAM technology. For instances, some studies found the fit of “CAD/CAM implant frameworks to be statistically superior to that of conventional cast frameworks”¹. It also has improved productivity and efficiency of prosthetic manufacturing processes within the dental lab. Continuous improvements to CAD/CAM technology have started to challenge the technique of fabricating dental implants and abutments using conventional methods.

Implant abutments should be made from biocompatible materials with adequate mechanical properties to meet the functional, biological and esthetic demands¹. Furthermore, they should “accurately and passively fit on their mating implants to prevent complications, such as screw loosening, bone loss and abutment fractures during function”¹. To achieve optimal mucogingival esthetics, dental implant abutments require the appropriate emergence profile needed to support the surrounding soft tissue, especially for esthetically driven patients¹.

Implant abutments can be either stock, cast custom or CAD/CAM custom abutments. The main advantage of stock abutments is their lower initial cost, but a major disadvantage is the ideal anatomic contour and emergence profile cannot be achieved. Cast custom abutments have similar tough mechanical properties to CAD/CAM custom abutments; however, the complicated fabrication process of investing, casting and finishing could be prone to manufacturing errors¹. Whereas, the use of CAD/CAM technology to design and manufacture custom abutments has been clinically proven to be extremely accurate due to the predictable nature of computer-aided manufacturing².

In a 2014 systematic review by Harvard School of Dental Medicine, researchers found CAD/CAM technology is able to provide results that are comparable to that of conventional techniques for implant survival, abutment survival, technical and biological complications². In the study, a total of 101 patients were treated with a total of 138 CAD/CAM implant abutments with the same patient group seen at 12, 36, and 67 months. Three different major CAD/CAM systems were used to fabricate the dental implant abutments: Procera (Nobel Biocare), Straumann Cares, and Zirconzahn. Amazingly, they found the CAD/CAM abutment survival rate is 100% and no complications were reported, including screw loosening or fracturing of the abutment².

In sum, CAD/CAM custom abutments have demonstrated survival rates comparable to conventionally fabricated abutments and have several advantages over other fabrication methods, allowing the technique to be a viable option for manufacturing custom implant abutments.  

About the Company

Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restoration outcome. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics given that material quality influences longevity of the restoration. Iverson Labs values their skilled team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration. Iverson dental labs strive to be a great dental resource for dental professionals by offering training on digital dentistry and new dental implant techniques at their cutting edge on-site operatory and training facility.

To inquire more about CAD/CAM custom implant abutments, please visit http://www.iversondental-labs.com or call us at (800) 334-2057.

Reference:

1. Kim, E., & Shin, S. (n.d.). Influence of the implant abutment types and the dynamic loading on initial screw loosening. The Journal of Advanced Prosthodontics J Adv Prosthodont, 21-21.

2. Kapos, T., & Evans, C. (n.d.). CAD/CAM Technology for Implant Abutments, Crowns, and Superstructures. The International Journal of Oral & Maxillofacial Implants Int J Oral Maxillofac Implants, 117-136.

How Patients’ Decisions Influence Treatment Planning in Restorative Dentistry

As part of treatment planning, you as the dentist introduce options to your patients. After a relaxed conversation, a treatment plan is agreed upon between you and your dental patient. You use the best available research-based literature, clinical experience and patient opinions to guide your treatment decisions. As a dentist, you exercise substantial influence on which treatment method is chosen. Patients’ decisions can lead to less than ideal, though clinically adequate, treatment plans that give patient satisfaction over the long-term¹. Patients’ decisions are most affected by their relationship with you as their dentist over factors such as time, access, and cost¹. Health service providers may affect the decision-making process between you and your patient if specific treatments are favored or excluded on financial grounds. Kalsi and Hemmings recommends letters should be sent to patients explaining the “nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs” and the consequences if no treatment is carried out¹.

Many psychological and social determinants influence patients’ values and decision-making when choosing a treatment plan in restorative dentistry. Frequently, a component of compromise between both parties in deemed acceptable even when clinical evidence indicates an alternative treatment to be more appropriate.

The best possible treatments should be based on the best available literature; however, the majority of treatment plans are greatly impacted by patients’ desires and expectations, which may not be based on sound knowledge¹. Patients’ wishes should be determined at the first treatment planning consultation to sort out whether they are realistic and possible within your own skill set, experience and knowledge¹. It is widely known that no dentist should perform any treatment that could harm a patient.

Time, number of appointments, use of anesthesia or sedative agents, pain and suffering are significant aspects to your patients’ decisions when selecting a treatment plan. You need to clarify biological and financial cost-benefit analyses to the patient¹. Also identify clinical factors, such as age, medical history and economics.

Patients seek dental treatment for three main reasons: comfort, aesthetics, and function. Patients are the real judge of whether their treatment is successful or not, so it is vital that they are pleased with their dental product¹. Their subjective assessments of a proposed treatment do not always correspond with their acceptance of evidence-based suggestions from clinical research literature. This assessment is contingent on the value patients accredit to a treatment. Aesthetic awareness can push patients to ask for destructive, biologically invasive work in situations where appearances could easily and equally be improved with lower risks of morbidity. For example, bleaching and bonding with veneers may “improve aesthetics with the same effect as full coverage crowns, with less tooth destruction and risk of dental pulp death and pain”¹.

Factors that affect patients’ decisions when deliberating treatment options:

•  Availability and access to care

•  Real cost per treatment option

•  Perceived value for money

•  Past dental history: positive or negative attitudes

•  Dentist’s confidence and competence

•  Patient’s confidence in dentist’s competence

•  Patient’s confidence in the treatment plan

•  Time and number of appointments

•  Perceived impact to quality of life

•  Pain and inconvenience associated with treatment¹

Interestingly, patients place more emphasis on your recommendations rather than on objective, evidence-based literature¹. If a dentist advocates a treatment, the patient is 2−21 times more likely to have it done¹. Comparatively, Kalsi and Hemmings found the endorsements made by evidence-based literature made no difference to a patient when choosing to proceed with a treatment. Confidence in your advice establishes the foundation of a professional relationship with the patient.

The significance of the dentist-patient relationship cannot be minimized, and a positive relationship is most likely to prompt a patient consenting for treatment. Patients put a lot of value on your recommendations. At the same time, patients want to play a collaborative role with you in the decision-making process. A treatment plan that is not evidence-based or approved with the patient runs the risk of losing a patient or, at worst, medico-legal action¹. However, treatment plans with an “element of compromise can be acceptable if, following full discussion with the patient, and taking into account all relevant factors, the benefits outweigh the disadvantages. This is the basis of informed consent”¹.

About the Company

Since 1991, Iverson Dental laboratories have provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restoration outcome. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics given that material quality influences longevity of the restoration. Iverson values their skilled team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration. Iverson labs strive to be a great dental resource for dental professionals, offering training on CAD/CAM technologies in digital dentistry and advanced dental implant techniques at their cutting edge on-site operatory and training facility.

To find more helpful resources about restorative dentistry or to inquire about our dental lab services, please visit http://www.iversondental-labs.com or call us at (800) 334-2057.

References:

1. The influence of patients' decisions on treatment planning in restorative dentistry. (2013). Dental Update, 40, 698-710.