Implant-Supported Full-Arch Restoration with A Malpositioned Implant In The Esthetic Zone Using Custom Abutment

“ Past, Present and Future of Dental Implants and Gerodontology ”, İstanbul, Türkiye, 9 - 11 Kasım 2023, cilt.27, sa.66, ss.178, (Tam Metin Bildiri)

Introduction: The success of an implant treatment is not only based on the achievement of the

osseointegration but also on the health of the surrounding soft tissues, dentogingival esthetics and

patient satisfaction. This is especially crucial for anterior implants where esthetics play a predominant

role in the treatment success. Esthetic complications can be caused either by malpositioned implants

or by inappropriate number and/or size of utilized implants. Although customized abutments are

not completely alternative to surgical relocation in a case where implants positioned incorrectly,

they are the prosthetic parts that enable the prosthesis to be obtained in an optimal way.

Objective: The objective of this study is to explain the ideal prosthetic treatment of an implant that is

incorrectly positioned in the esthetic zone with a custom abutment.

Case: A 72-year-old female patient was referred to our faculty from another clinic for an implant-

supported fixed prosthesis. In the clinical examination, it was observed that 6 implants were placed in

the lower jaw and 7 implants in the upper jaw. An implant in the anterior region of the upper jaw was

placed outside the crest with an extreme labial angle. No problem was observed in the osseointegration

of the implants during clinical and radiological examination. Since the thickness and height of the residual

bone was insufficient to place a new implant in the anterior region and the patient refused a new surgical

procedure, it was decided to use the existing implant. The entryway of the permanent restoration was

evaluated with the use of a software and it was seen that the malpositioned implant was placed with

42,6° in the orofacial direction. The existing stock abutment options for the malpositioned implant were

inadequate to ensure the entryway of the prosthesis and provide the esthetics. For this reason, a premill

abutment was designed and manufactured with a CAD/CAM software (exocad Gmbh) in accordance with

the patient’s smile line and the entryway of the prosthesis. Then, the esthetic and functional properties

of the permanent prosthesis were evaluated by producing a provisional restoration, which was made

from polymethyl methacrylate (PMMA) with 3D printing. Necessary arrangements have been made for

the final restoration. The distance between implants and the length of the edentulous space have limited

the use of zirconia as a restoration material therefore porcelain-fused-to-metal restoration was preferred.

Finally, an implant-supported full-arch restoration was applied to the patient using a custom abutment.

Conclusion: Positional and angular complications may occur with implants that are not prosthetically planned.

Choosing the ideal abutment, especially in the anterior region, is important for the biological compatibility of

the final prosthesis, as well as for providing the entryway and achieving an esthetic restoration. It is thought

that the use of custom abutments produced by CAD/CAM is a good alternative to stock abutments for

implants which are incorrectly positioned in the esthetic zone.

Keywords: custom abutments, full-arch restoration, implant dentistry

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