JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No.

1 (82 - 83): Locating Angulated Abutments: A Technical Note Trevor J. Cow

Locating Angulated Abutments: A Technical Note

Trevor J. Coward, M Phil/Roger M. Watson, BDS, MDS, FDSRCS

A simple laboratory-made acrylic resin guide offers rapid location of angulated abutments
after the healing abutments are removed. An impression recording the relation of the implants
to the dental arch enables the choice of abutments to be made in the laboratory. The precise
position and angulation of each abutment can be transferred to the mouth.
(INT J ORAL MAXILLOFAC IMPLANTS 1997;12:82–83)
Key words: angulated abutment, implant, laboratory technique

D ifficulties arising from the divergence of the tooth crown in the dental arch and the implant located
in the jaw have been overcome in the production of new angulated abutment components (Nobel Biocare
AB, Göteborg, Sweden) to support an implant prosthesis.1-4 Positioning of angulated abutments (ie, 17
and 30 degrees) may be required to allow prosthesis placement and to avoid placing the access hole for
retaining screws in the buccal or labial sides of tooth restorations that cannot otherwise be managed with
conical or straight-shouldered abutments (ie, EsthetiCone, CeraOne [Nobel Biocare AB]).
The choice of appropriate components is usually delayed until a master cast is poured from an
impression recording the hexagonal head of the implants in relation to the dental arch (Fig 1). Laboratory
replica abutments make this easier. However, positioning in the mouth of the selected angulated
abutment precisely in the planned direction is not easy, even if the abutment holder recommended by the
manufacturer is used. To avoid potential problems, an abutment guide can be prepared in the laboratory.
Method
The chosen angulated abutment is screwed to the replica implant in the desired position. Either a waxing
post or abutment holder is used to locate a modified cylinder on the abutment (Fig 2). Undercuts on the
adjacent natural teeth are waxed out on the dental cast. Light-curing resin is then adapted around the
modified provisional resin cylinders seated on the abutments, leaving only sufficient access to the
abutment screw. The material is extended onto each of the adjacent abutments and onto the occlusal
surfaces of the abutment natural teeth. The resin is smoothed and cured in a light box (Fig 3). The
titanium angulated abutments are unscrewed and sterilized. Each is positioned in turn in the modified
cylinders within the guide and is secured with the waxing post (Fig 4).
When the 17-degree abutment is used, it is necessary to position the gold alloy abutment screw within
the abutment before the waxing post is tightened in the guide. The guide is held just above the arch to
allow the gold abutment screw to be introduced, and it is screwed one to two turns into the orifice within
the hex head of the implant. The abutment guide is carefully lowered onto the occlusal surfaces of the
natural teeth to allow the abutment to engage the hex in the correct path of approach necessary for mating
the components. It is important not to snag the threads of the gold screw against the abutment during the
maneuver. (This problem does not arise with the 30-degree abutment screw, where the head is a different
form. This screw can be introduced through the open face of the abutment once it is correctly seated on
the implant.) Further hand tightening of the abutment screw, as recommended by the manufacturer,
ensures the correct contact of the abutment and implant surfaces. The waxing post is unscrewed to
release the guide, and the procedure is repeated for the next angulated abutment.

Article Text 1
JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No. 1 (82 - 83): Locating Angulated Abutments: A Technical Note Trevor J. Cow

The abutments are covered by healing caps after a new master impression is recorded using abutment
transfer impression copings, or the angulated abutments may be removed and replaced with healing
abutments while the prosthesis is fabricated.
Conclusion
A method is described whereby angulated abutments can be rapidly positioned in the desired positions on
the implants. The manufacture of a less costly modified stainless steel cylinder would further improve the
system to permit their use in an individual customized holder for future occasions.

Trevor J. Coward

Senior Dental Instructor, King’s College School of

Medicine and Dentistry, London, England.

Roger M. Watson

Professor of Dental Prosthetics, King’s College

School of Medicine and Dentistry, London,
England.

FIGURES

Footnotes 2
Figure 1

Fig. 1 Master cast containing replica implants. A 30-degree 5.5-mm replica abutment selector is
positioned on the posterior distal implant to demonstrate the correct alignment for the fixing
screw hole. An impression fixing screw is in position in the mesial anterior replica component to
indicate the lingual direction of this implant. A 17-degree 2-mm angulated abutment will be
needed here.

Figure 2

Fig. 2 Modified resin cylinder providing access for the abutment screw of the angulated
abutment.

Figures 3
JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No. 1 (82 - 83): Locating Angulated Abutments: A Technical Note Trevor J. Cow

Figure 3

Fig. 3 Resin abutment guide positioned on the cast of a resected mandible to be restored with
a fixed partial prosthesis. The modified resin cylinders locate the mesial and distal angulated
abutments on the implants.

Figure 4

Fig. 4 Resin abutment guide enclosing the modified resin cylinders screwed onto the posterior
angulated abutment for a fixed partial prosthesis. The waxing posts have been scored to show
that the abutment is completely seated in the cylinder of the guide.

Locating Angulated Abutments: A Technical Note Trevor J. Coward, M Phil/

1. Kallus T, Henry P, Jemt T, Jörnéus L. Clinical evaluation of angulated abutments for the Brånemark system: A
pilot study. Int J Oral Maxillofac Implants 1990;5:39–45.

References 4
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2. Watson RM, Davis DM, Forman GH, Coward T. Considerations in design and fabrication of maxillary
implant-supported prostheses. Int J Prosthodont 1991;4:232–239.
3. Gelb DA, Lazzara RJ. Hierarchy of objectives in implant placement to maximize esthetics: Use of preangulated
abutments. Int J Periodont Rest Dent 1993;13:277–287.
4. McCartney JW, Vermilyea SG, Fosdal T. Modification of angulated abutments to avoid unesthetic display of
metal. J Prosthet Dent 1993;69:439–441.

References 5