Even though my practice is in Manhattan and there are plenty of great dental laboratories in NYC, I choose to send my implant case models to a Boston Lab called Atlantis , to fabricate custom cad cam designed implant abutments. Although Atlantis was recently acquired by Astra, they continue to be the lab I choose to manufacture most of my implant abutments.
They can precisely machine these abutments to a dentist’s specifications and have been doing so for a long time. They can fabricate their custom work for an ever growing number of implant brands and can make them out of a number of materials including titanium, gold plated titanium and zirconium.
Their customization allows a dentist to specify the width of the abutment and the depth under the gingival of the chamfer. Having this flexibility tends to provide final outcomes that are truly aesthetic and allow for optimal gingival health.
When the implant crown is cemented, using a custom abutment insures that margins are not too subgingival and makes it easy to completely remove dental cement. Standard stock abutments can have margins that are so far below the gums that cement removal can be unpredictable. Cement that is not completely removed can cause an inflammatory response in apatient’s gingiva and can even responsible for the loss of an implant.
Using a commercial lab in another city can add several extra days of waiting time for an implant abutment to be returned, but I feel the results are worth it. Once I receive the abutment(s), I try them in the mouth to check for fit and then I remove them and have a crown fabricated directly on the abutment.
Crowns made in this manner tend to have a better and more predictable fit that crowns made from silicone impressions of the abutments after they have been inserted in the mouth. Once the crown is fabricated, it is usually and easy matter to insert both the abutment and the crown in the same visit.