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Lab Sense - Best in Class: Inclusive Custom Abutments

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Dzevad began his career at Glidewell Laboratories while attending Pasadena City College's dental laboratory technology program. In 1999, Dzevad began working at Glidewell as a waxer and metal finisher, then as a ceramist. After being promoted to general manager of the Full-Cast Department, he assisted in facilitating the lab's transition to CAD/CAM. In June 2008, Dzevad took on the company's rapidly growing Implant Department, and in 2009 completed an eight-month implants course at UCLA School of Dentistry. Today, Dzevad leads an implant team of more than 250 employees and continues to implement cutting-edge CAD/CAM technology throughout his department. Contact him at inclusivemagazine@glidewelldental.com.

Grant Bullis, director of implant R&D and digital manufacturing at Glidewell Laboratories, began his dental industry career at Steri-Oss (now a subsidiary of Nobel Biocare) in 1997. Since joining the lab in 2007, Grant has been integral in obtaining FDA 510(k) clearances for the company's Inclusive® Custom Implant Abutments. In 2010, he was promoted to director and now oversees all aspects of CAD/CAM, implant product development, and manufacturing. Grant has a degree in mechanical CAD/CAM from Irvine Valley College and an MBA from Keller Graduate School of Management. Contact him at inclusivemagazine@glidewelldental.com.

Over the past five years, the Implant department at Glidewell Laboratories has witnessed a tremendous rate of growth in the demand for its line of Inclusive® Custom Abutments (Fig. 1). By pioneering advancements in the computer-aided design and manufacturing techniques used to produce these patient-specific restorations, the laboratory has developed and refined processes that are far more predictable, more precise,1 and more efficient than traditional waxing and casting techniques. The end result is a custom solution at or near the cost of a generic, prefabricated abutment, making it the first choice of a growing number of clinicians.

Custom Abutments or Stock Abutments

The clinical benefits of patient-specific implant abutments have been well documented in the dental literature. A prefabricated "stock" abutment lacks the flexibility in form to address the unique challenges, individual complexities, and esthetic demands of a given case. In the majority of implant cases, the patient is best served by an abutment specifically tailored to the natural emergence profile of the tooth being replaced, the morphology of adjacent and opposing dentition, the presence of defects, and proper support of the eventual restoration, among other factors.2 To provide optimal function and esthetics, stock abutments must often be modified by the lab to establish suitable height, margins, and path of insertion, which can vary, depending on the location and angulation of implant placement. Not only does this modification process provide a less than ideal emergence profile, but the cost is often as much or more than the cost of a custom abutment.

Glidewell provides an acrylic jig with each Inclusive Custom Abutment to help ensure swift, accurate seating, thereby minimizing chairtime and patient discomfort (Figs. 2a, 2b). Once delivered, these patient-specific abutments promote peri-implant health through proper support and management of the soft tissue with a properly placed margin, which facilitates cement removal during delivery of the final restoration (Fig. 3).

Digital Custom Abutments or UCLA Abutments

Since its introduction in 1987, the universal clearance-limited abutment (UCLA) has enabled technicians to create the wax-up of a custom abutment by hand, allowing them to design abutments that adapt to conditions of restricted occlusal and interproximal clearance. While suitable in most clinical situations, the UCLA process can be tedious, time-consuming, and less precise3 for both the clinician and laboratory. Given the high cost of noble metals, and the intensive laboratory procedures required to fabricate the final solution, an overwhelming number of clinicians are switching from UCLA abutments to digital custom abutments (Fig. 4).

Digital Inclusive Custom Abutments or Other Digital Custom Abutments

With a greater number of clinicians choosing the esthetics, function, and efficiency of CAD/CAM custom abutments, it bears looking at some of the industry-leading options available today. Dedicated to providing the highest-quality implant prosthetics possible, Glidewell Laboratories continuously improves the technologies, materials, and processes used to design and manufacture its Inclusive line of products. Recently, the lab's research and development department conducted a same-case, microscopic comparison of an Inclusive Titanium Custom Abutment alongside patient-specific titanium abutments from two other leading manufacturers. Scanning electron microscopy (SEM) images provide an up-close look at the critical implant-abutment interface of these competing solutions (Fig. 5).

Seen from this highly magnified view, the Inclusive Custom Abutment presents favorably in relation to its peers. The Inclusive abutment exhibits smooth transitions between features, an absence of burs or tooling marks, and an excellent finish of the mating surface. The second sample lacks a smooth transition between features, displays more pronounced roughness of the mating surface, and exhibits an inconsistent blend line in the gingival portion of the abutment. The third sample exhibits burs on and around the mating surface and connection geometry, and a tri-lobe interface with geometry that differs from the implant's prosthetic connection. The clinical relevance of these defects could include an increased potential for micro-leakage4 between implant and abutment, and a higher risk of screw loosening5 caused by a less intimate fit around the connection.

The fit and finish displayed in these images are indicative of the commitment at Glidewell Laboratories to achieve and maintain an unsurpassed level of quality. As the world's largest dental implant laboratory, Glidewell leverages the expertise of dozens of certified dental technicians in the design of its prosthetic components. The abutment manufacturing division is ISO 13485 certified, and operates under FDA Current Good Manufacturing Practices (CGMPs). The lab's abutments are produced on high-precision Swiss lathes and multi-axis milling machines. As the leader in digital dentistry, Glidewell employs an experienced staff of engineers and machinists to ensure that each abutment they produce is one that clinicians and their patients can rely on.

Inclusive Custom Abutment Options

Inclusive Custom Abutments are available in titanium, all-zirconia, or hybrid (zirconia with titanium base) options. A titanium abutment (Fig. 6) is the most frequently prescribed, particularly in the posterior. An all-zirconia abutment (Fig. 7), favored for its more natural esthetics, is indicated for all areas of the mouth, and is a popular choice for anterior restorations. A hybrid abutment (Fig. 8) combines the esthetics of a zirconia coping with a titanium abutment connection, resulting in a all-titanium implant-abutment interface. All three varieties are compatible with a number of popular implant systems (Fig. 9), in addition to their compatibility with the Inclusive® Tapered Implant System. While other custom abutment manufacturers can accept digital files from a few dental scanners, Glidewell Laboratories accepts and works with files from almost any digital scanner or design software, providing industry-leading flexibility for both clinicians and laboratories (Fig. 10).

Inclusive Tooth Replacement System

The Inclusive® Tooth Replacement System, is a comprehensive, restorative-driven treatment package with patient-specific temporary components that begin sculpting the soft tissue from the moment of implant placement. It features a matching custom impression coping for transferring the final soft tissue architecture to the laboratory. Taking advantage of these tissue contouring components ensures that the patient's soft tissue is ideally prepared to provide a natural emergence profile (Figs. 11a, 11b). This helps to mitigate the painful and disruptive blanching often associated with seating a final abutment through tissue that has been left to form around a stock healing abutment.

Summary

A prefabricated implant abutment is often viewed as the most immediate, least expensive option for restoring implant cases. But a patient-specific abutment that takes into consideration the unique anatomical qualities of the patient's edentulous space will, in most situations, provide more reliable function and more natural esthetics, maximizing long-term health and performance. As technological advancements decrease the costs associated with the design and manufacture of digital custom solutions, clinician demand for traditional cast and stock abutments is rapidly waning in favor of CAD/CAM precision and efficiency. Available for most major implant systems, Inclusive Custom Abutments consistently deliver the high quality that clinicians expect.

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