An implant abutment creates the interface between the final restoration (in this case, a crown) and the implant. It provides for the exact depth and angulation necessary to create a natural final result. In this illustration, the crown is depicted as translucent in order to show the abutment. The fixation screw is not pictured in this diagram. For a more annotated picture of the relationship between an abutment and an implant, please click here: Abutment Diagram.

In the case of titanium or zirconia abutments, the final components are custom milled by computer controlled machinery in New Jersey, Boston, Sweden, or Japan (in order of prevalence in our office). This is sometimes done by the dentist or laboratory technician first creating an abutment out of wax or plastic, then scanning it into a computer. In other cases, such as this one, the abutment is created entirely in a CAD / CAM environment at our office by Dr. Hart and then sent electronically for milling. This image depicts the completed abutment design (done at our office) immediately prior to transmission to New Jersey.

From top to bottom: (1) Fixation screw (or "set screw), (2) Abutment (with flashing to be cut off), (3) Top of Implant. Note the gold colored component at the bottom of the implant. This is for greater strength at the abutment-to-implant interface for a zirconia abutment. It is typical of a Nobel Biocare zirconia abutment, but not of others. This is why we favor this particular manufacturer's custom zirconia abutments.

An important element of an implant restoration is the fixation screw. This is analogous to a "set screw" that is used in other mechanical situations. The implant abutment "plugs in" to the implant, and then the set screw is threaded through the abutment and into the implant.

In the "early days" of implants (the 1980's), one of the problems was the loosening of the set screw over a period of time. This has been solved. In contemporary implants, there is a precise matching of the alloy of the screw, the implant, and the force that is applied to the screw to affix the abutment. The fixation screw is carefully tightened to a specific torque using a miniature precision torque wrench which is, believe it or not, similar to a spark plug wrench used in automobiles!

An installed titanium abutment. Once an abutment has been placed, and the fixation screw has been torqued to the correct force, the resulting assembly is ready for the placement of the crown, in a very similar manner to a natural tooth that has been prepared for a crown.

This is a photo of a gold custom abutment. This type of custom abutment was used frequently in the 1990's, and is still appropriate for certain cases today. Specifically, if your implant is too "high" (too close to the exterior gum line), or too "deep", the atypical contours that need to be created are better suited for the waxing and gold casting procedures used to make this kind of abutment. Also, sometimes, when a narrow implant is used, circumstances render use of a zirconia abutment as possibly being too weak; and gold creates more esthetic gum tissue colors than titanium. This photo is not from the same case as the other photos, but I included it to show as an example. Gold was chosen because the underlying implant was narrow, and slightly deeper than ideal. When gum tissues are pink, they are healthy. Note the health of the gum tissue surrounding this abutment.

Finally, the crown is cemented onto the abutment, just like a regular crown is cemented onto a tooth!

The final crown in place. When it comes to color matching, sometimes it is best to blend with the "less than white" appearance of the neighboring teeth. In this case, note that while we matched the basic tooth shades of the canine (eye tooth) in front of the implant, we chose not to duplicate the tobacco stains.