Custom abutments.
A stock abutment comes in a limited range of heights, angulations and emergence profiles. A custom abutment is designed for the case, and there are four situations where that is worth the difference.
When custom earns its place
Deep or uneven soft tissue, where a stock abutment margin would end up substantially subgingival on one aspect and supragingival on another.
An implant whose axis diverges from the intended crown axis, where the correction is better made within the abutment than in the crown above it.
An anterior case where emergence governs the aesthetic result. And any case where the emergence profile developed by a provisional needs reproducing rather than approximating.
Margin position is the main advantage
A custom abutment lets the margin be placed at a chosen depth around the entire circumference — typically just below the tissue interproximally where aesthetics matter, and at or above tissue level buccally and lingually where cement removal matters.
That single capability is what makes cement retention safe. A margin at or slightly above tissue level allows excess cement to be seen and removed; one two or three millimetres subgingival does not, whatever technique is used.
Residual subgingival cement is strongly associated with peri-implant inflammation. See cement versus screw retention.
Material
Titanium abutments are strong, well tolerated and the default for posterior work. Zirconia abutments, usually bonded to a titanium base, give better aesthetics where the tissue is thin and a metal abutment would show through as a grey shadow.
A one-piece ceramic abutment engaging the implant connection directly is possible and carries a genuine concern: a hard, unyielding ceramic interface against titanium can wear the implant's internal geometry over time. A titanium base avoids that.
See titanium bases.
Design inputs
The tissue depth around the implant, the intended crown axis, whether the restoration will be screw or cement retained, and the emergence profile you want reproduced.
Scan or impress the emergence before placing the scan body or coping if the profile matters — the sulcus begins to collapse within minutes of removing a healing abutment, and the component then obscures the region the abutment has to be designed around.
Where a provisional has developed the profile, record the provisional itself and send it. It is more informative than any description.
Space
Interocclusal space is shared between the abutment and the restoration above it. A custom abutment can be designed to the height available, but it cannot create space that is not there.
Where clearance is tight, say so before components are ordered. Both component selection and restoration design change, and a titanium base needs adequate height for the bond that retains the ceramic above it.
Screw channel through the abutment
A custom abutment is itself screw-retained to the implant, so its own channel position is set by the implant axis. Where a crown is then cemented over it, the abutment screw remains accessible only by removing the crown.
That is worth planning around. If the case is likely to need the abutment screw retightened — a single unit in heavy function, or a case where loosening has already occurred — a screw-retained crown or an extraorally cemented assembly preserves access.
Record the channel position in the notes either way. Locating it later through a cemented crown is considerably harder than reading it from a record.
What to send
System, product line, platform and connection. Intended retention. The emergence profile you want, ideally recorded rather than described. Tissue depth if unusual. Any concern about space or angulation.
More in Implant Restorations
Send a case
Digital scans and conventional impressions are both accepted. Cases move by UPS and Purolator, and Fairmont works with practices throughout British Columbia and across Canada.