The Branemark System Angulated Abutment
The angulated abutment by Nobelpharma is a very innovative component designed to adjust access hole position, prosthetic screw angulation and improve cosmetics. This thirty-degree, twelve-sided, internal-designed component offers twelve different positions to drastically change the angulation of a severely misaligned implant.
Many times it is possible to determine the need for an angulated abutment at the time of second stage surgery (the abutment connection). It is also possible for the experienced technician to inform the clinician of the need for the angulated abutment after the casts are articulated.
Before the development of this abutment, if screws and access holes were positioned jutting through the labial aspect of an anterior tooth, there were basically three options: 1) the double casting technique as previously described; 2) unsightly patch marks which closed the access holes after final insertion; or 3) the combination of implant-supported posts securing a crown and bridge-type prosthesis.
The cast (Figure 9-25) described in this section presents with regular abutments in place at second stage surgery. After articulation (Figure 9-26), esthetic problems are evident.
A prosthesis is fabricated (Figure 9-27) with teeth flared and aligned in a manner to hide the access hole.
The angulated abutment with the abutment screw which screws directly into the internal threads of the implant is shown here.
The angulated abutment can be positioned twelve different ways. This is a view of the underside.
The entire angulated system: implant, angulated abutment and abutment screw, gold cylinder and prosthetic' screw, brass replica, impression piece, and healing abutment.
This is the master cast, with regular abutments showing unfavorable labial inclination.
As the casts are articulated, the unfavorable inclination becomes more evident.
An initial prosthesis was fabricated using the traditional hardware. Note the unsightly miscoloured central incisor. The access hole in this tooth is filled with cold cure acrylic because the alignment of the implant caused the screw to protrude through the labial surface. After months of wear, the resin changed color, as many cold cure resins will do. A light-cured material can be used, but it is difficult to accurately match tooth shades.
These severely misaligned implants are drastically improved by use of the angulated abutment.
Two angulated abutments are shown intraoral. Note the screw access hole that allows the use of a screwdriver to secure abutments to the implant.
The healing abutment is shown being attached to the angulated abutment and implant.
NOTE: The healing abutment is used as a precautionary device to inhibit tissue growth around the areas where the angulated cylinder will make contact in the finished prosthesis. This is used while the surrounding tissue heals and during fabrication of the prosthesis.
The healing abutment is shown in place.
Implant, angulated abutment, im-pression coping and guide pin.
This intraoral photo shows the impression copings in place. Compare the original articulated casts in Figure 9-26 with the angulated abutments to observe the drastic change in the angulation of the guide pins.
The master impression shows good adaptation around the impression copings. It is now ready to have the brass replicas placed and the master cast poured.
Brass replicas for angulated abutment.
The cast is poured with improved die stone.
The gold cylinders are in place.
The teeth are set in wax and tried in for esthetics, form, and function.
The gold framework is waxed, cast, and verified intraorally and radiographically for fit. The teeth are set to frame and processed.
The restoration is polished and ready for insertion.
This is a view of the underside of the restoration. It is very important that the gold framework be highly polished -to reduce plaque buildup.
The patient shows greatly improved esthetics, with all anterior access holes hidden to lingual of the prosthesis.