A simplified technique to fabricate a custom milled abutment

Christopher B. Marchack, DDS,a Frank M.A. Vidjak, DDS, MSEd,b and Vivian Futatsuki, DTc University of Southern California, School of Dentistry, Los Angeles, Calif
There are multiple techniques to create custom abutments, some more difficult to use than others for replicating the exact shape and form of the accepted provisional restoration. Techniques include the use of (1) add-to abutments, premachined abutments to which gold or porcelain is added, (2) preparable abutments, referring to the preparation of abutments that have been manufactured in a bulk material, such as porcelain or titanium, (3) computer-assisted design and computer-assisted manufacturing (CAD-CAM) abutments, using a computer program to custom mill an abutment, and (4) copy milling, using a scanner and computerassisted manufacturing.1,2 With copy milling, an abutment is typically contoured in wax, then scanned to create the abutment. Creating a wax replica of the provisional restoration is time-consuming and may not exactly replicate the transitional contours of the provisional restoration. This article presents a simplified technique to create a custom abutment replicating the exact transitional contours from the provisional restoration in titanium, alumina, or zirconia using a scanner and computer-assisted manufacturing. The abutment can be produced for multiple implant systems such as Nobel Biocare (Nobel Biocare USA, Yorba Lina

da, Calif ), ITI (Straumann AG, Basel, Switzerland), Astra (Astra Tech AB, Molndal, Sweden), Zimmer (Zimmer Dental, Carlsbad, Calif ), and other external hex implants replicating the hex design of a Branemark implant.

PROCEDURE
1. Fabricate a provisional restoration direct to the implant (NobelReplace; Nobel Biocare USA) that meets the expectations of the clinician and patient (Fig. 1). 2. Remove the provisional restoration from the implant. Connect the provisional restoration to an implant replica (Implant replica NobelReplace; Nobel Biocare USA) and set it into impression plaster (Snow White

#2; KerrHawe SA, Bioggio, Switzerland). 3. Syringe a heavy-body vinyl polysiloxane (Access Blue; Centrix, Shelton, Conn) around the provisional restoration, from the implant interface to the incisal edge. After the impression material polymerizes, remove the provisional restoration and replace it onto the implant (Fig. 2, A). 4. Place a temporary cylinder (Temporary abutment plastic engaging NobelReplace; Nobel Biocare USA) onto the implant replica. 5. Fill the space between the impression material and the temporary cylinder with acrylic resin (Jet Acrylic; Lang Dental Mfg Co, Wheeling, Ill) or a bis-acryl (Access Crown; Centrix) to the incisal edge of the impression,

1 Provisional restoration for maxillary right central incisor fabricated with transitional contours to support transitional tissues.

Associate Clinical Professor, Department of Continuing Education. Associate Professor, Department of Clinical Dentistry. c Private practice, Pasadena, Calif.
b

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2 A, Provisional restoration connected to implant replica, set in impression plaster. Heavy-bodied impression material encompasses provisional restoration and implant replica to incisal edge. B, Index for implant replica and impression of provisional restoration is created after removal of prosthesis.

3 Duplicate provisional restoration on soft tissue cast. Soft tissue height is marked and provisional restoration is prepared.

4 The milled zirconia abutment, duplicating provisional restoration subgingival contours.

creating a duplicate of the provisional restoration (Fig. 2, B). 6. Once the material polymerizes, prepare the provisional restoration duplicate with a dental handpiece and burs to create an ideal tooth preparation which can support a metal-ceramic crown or an all-ceramic crown (Fig. 3). 7. Scan the prepared resin dupli-

cate with a scanner (Procera Forte Scanner; Nobel Biocare USA) for a custom copy-milled abutment (Fig. 4).

for the anterior single-tooth implant. J Prosthet Dent 1996;76:288-91. Corresponding author: Dr Christopher B. Marchack 301 South Fair Oaks Avenue, Suite 408 Pasadena, CA 91105 Fax: 626-793-8777 E-mail: cmarchack@aol.com Copyright 2007 by the Editorial Council for The Journal of Prosthetic Dentistry.

REFERENCES
1. Marchack CB, Yamashita T. A procedure for a modified cylindric titanium abutment. J Prosthet Dent 1997;77:546-9. 2. Marchack C. A custom titanium abutment

Marchack et al