Implants have become a routine part of most dental practices with a lot of general dentists placing and restoring implants. Not all restored implants are the same, however. It all starts at the beginning with proper planning of implant position.
One of the challenging things in restoring implants replacing molars is that there is a large difference between the size of the molar and the size of the implant. Implants placed in the molar areas are typically about 5 mm in width, but the actual crown is typically about 10 mm in width which is quite a bit to transition to in a sometimes short tooth.
Here is where proper planning comes into play. The X-Ray on the left is an example of what not to do. The implant was not placed deep enough putting the platform of the implant (where the crown connects) in the wrong position. You can see how the implant and crown almost look like a lollipop. The issue with this is it creates a crown that is the wrong shape and not what was there before. It also creates areas that are really difficult to clean causing gum discomfort, swelling, and leading to infection around the implant and possibly loss of the implant. We need some room to be able to properly transition from a narrow implant to a large molar. We can help create room by placing the implant deeper and scalloping the area to the proper profile.
Another issue is with healing abutments. A healing abutment is what molds the tissue and creates a "tunnel" thru the gum to the implant. Almost all dentists including specialists use "stock" healing abutments (on left). They come in various heights and widths but they are always circular. The crown that connects to the implant is never a circle. This can be overcome by using custom-made healing abutments as shown on the right. This creates a tissue profile that is shaped like the crown that will go on top.
This allows us to create a custom abutment that is the proper shape which in turn allows us to make a crown that looks like a molar. This also makes it easier to keep clean since the abutment and the crown properly fill the space between the teeth. You can see in the X-ray below that the implant was placed deeper which allowed a properly sized abutment and crown to be placed.
