Exploding abutments

We have seen some major issues recently with the use of ‘fake’ abutments on implants we have placed.    One such case is seen here where the referring dentist did not use Ceramic Designs and sadly this has harmed everyone involved.    The lab used promised that they were experienced in implant restorations but made several mistakes that have left a patient feeling that implants are a disastrous option. 

The lab used a copycat cut price abutment, and this was without informing the dentist.   They then prepped the abutment down so that there was almost no support for the crown as you can see from the images.   The final straw was that they used EMax – a beautiful restorative material, but just not strong in comparison to the latest Zirconias available. 

You can see how the base of the crown has shattered,  and this is not surprising when you look at the periapical of the abutment that is in situ. 

Sadly this patient had 3 such restorations.   2 shattered in quick succession, and the third was obviously replaced before the same thing happened.   Fortunately the cost of the labwork was refunded, and Ceramic Designs resolved the issue with the correct Dentsply TiBases and Zirconia core crowns with a ceramic veneer.  This is our recommended solution for nearly all of the implants places at The Implant Centre. 

The other periapical images show some of our concerns we now have with the Atlantis abutments we are seeing coming through.   This is a Dentsply company (they have taken over most dental companies!) that makes custom milled abutments for many implant systems.   This has transformed what implant dentists can do safely with cement  retained restorations on implants, but as we do the majority of our work screw retained then this is not needed as shows no benefit over the TiBases you will be used to seeing from us.

What appears to be happening is some labs are using this system (which is fine), but using it incorrectly.  The abutments are being milled wafer thin where the screw head is, and this is an area we have seen fracture a few times.  We are very sure that as more badly designed abutments are loaded they will fracture after a few years of metal fatigue.    Please be very aware to make sure lab you use knows how to plan this aspect of the restoration, or of course save all your heartache and just use Ceramic Designs.