Custom abutments on tilted implants in the maxilla: A clinical report

Area of Science:

• Dental Implantology
• Prosthodontics
• Biomaterials Engineering

Background:

• Implant-supported restorations require precise alignment for long-term success.
• Severe angular divergence between implants can compromise prosthetic stability and component integrity.
• Maxillary anterior implant placement presents unique anatomical challenges.

Observation:

• A case involving two maxillary dental implants supporting a cement-retained bridge presented with severe disparallelism.
• Fracture of an abutment screw and the abutment itself occurred in one of the implant restorations.
• Measurement revealed a significant 39° angle of divergence between the two implants.

Findings:

• Custom-angled titanium abutments were fabricated to compensate for the 39° implant divergence.
• A new metal-ceramic splinted crown restoration was designed to connect the two custom abutments.
• This prosthetic solution aimed to achieve passive fit and distribute occlusal forces effectively.

Implications:

• Custom abutments can correct significant implant angular discrepancies, enabling prosthetic rehabilitation.
• Addressing severe implant divergence is crucial for preventing mechanical complications like abutment fracture.
• This case highlights the importance of meticulous planning and advanced fabrication techniques in complex implant cases.