Darin O'Bryan, D.D.S. Certain implant systems have the disadvantage of having very narrow healing caps. This is problematic when trying to create custom abutments or contoured screw retained crowns. When you have a narrow healing cap tissue binding of the abutment or crown is very possible. The solution for this is to have a wider healing cap to help train the tissue to a more favorable profile during the integration phase. You can make a releasing incision but this requires more anesthetic, which the patients don’t like and makes the whole process more involved.
If the implant system you use has narrow healing abutments you either need to order a different healing cap from a compatible company which adds cost. The other option is to make a custom healing abutment from a stock healing abutment.
This is done by roughening up the surface above the implant interface with either a diamond bur or with air abrasion. A metal coupling agent is then applied. In this case I used Monobond Plus from Ivolcar. After the coupling agent has set, apply flowable composite into the shape that you want the final contours to be or just slightly shy of what they will be. This may require curing in increments if you have to add a lot of composite. Make sure not to let it flow into the driver engaging hole. This custom healing abutment is then put into place on the implant and allowed to heal.
The tissue will heal around this custom healing abutment and leave you with nice tissue contours.
This allows you to seat your restoration with minimal binding. It also helps prevent the need for anesthetic or a releasing incision.
