This summary is based on the article published in the Journal of Esthetic and Restorative Dentistry: Clinical outcomes of implant abutments in the anterior region: a systematic review (June 2013)
Context
Current paradigms for treatment success in implant dentistry are based not only on true clinical outcomes, such as implant survival, restoration survival, and patient satisfaction but also on surrogate clinical outcomes such as dentogingival esthetics, rate of mechanical complications, bone levels, and health of surrounding soft tissues. This is especially important for implant therapy in maxillary and mandibular anterior regions, where esthetics play a predominant role in treatment success.
Purpose of the Study
- The clinical outcomes of anterior implant abutments are not well reported.
- Systematically review the existing literature to identify survival, mechanical, biological, and esthetic outcomes of anterior implant abutments.
Key Messages
- Minimal anterior abutment fractures have been reported and are restricted to ceramic abutments.
- Studies using spectrophotometry showed lesser gingival discoloration with zirconia abutments, but there is no evidence for difference in patient’s esthetic satisfaction between ceramic and metal abutments.
- For the anterior region, selection of an implant with internal connection and a customized metal abutment (titanium or cast metal) can have the least mechanical complications.
- Limited existing clinical data indicate reduced peri-implant mucosal discoloration from zirconia abutments, which may be preferable over metal abutments, in patients with thinner mucosal tissues or patients with high or gummy smiles.
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I agree that standard metal milled abutments rarely work in dental implants placed in anterior locations of the mouth. Most times the angulation of the jawbone and the placement angle of the implant dictate that a custom-milled abutment be used to anchor the crown on the implant.
Zirconia milled custom abutments cost about the same nowadays as a milled Titanium alloy abutment, and the zirconia is way more aesthetic in this zone. Moreover, I found that here in the Toronto Mississauga area, people expect a near perfect result for each and every case, so using a provisional crown for up to two months and then making the custom zirconia abutment & crown gives the best chance for success; functionally as well as aesthetically.
Keep up the good research!