Surgical and prosthetic criteria for selecting prefabricated vs custom implant abutments

The abutment is an integral part of a prosthetic dental implant restoration. Both prefabricated and custom abutments aim to ensure proper gingival contours, maximum crown retention, proper emergence profiles, and the desired subgingival depth of the crown margins. To achieve good outcomes, abutment selection must be guided by biologic and prosthetic principles. In this narrative review, the dental literature was searched for articles addressing criteria used to select dental implant abutments. The literature indicates that both prefabricated and custom abutments can be used to enhance restorative therapy. A variety of clinical scenarios that cannot be resolved with prefabricated abutments (eg, excessive interocclusal space) can be managed with custom abutments. Technological advancements, such as computer-aided design/computer-aided manufacturing, can help attain clinical benefits usually accomplished with traditionally made custom abutments. The review identified 15 surgical and prosthetic criteria that can be used to guide the selection of prefabricated vs custom dental implant abutments: implant position, implant angulation, sink depth, emergence profile, collar height, peri-implant crevicular depth, esthetics, restorative margin location, cement removal, running room, diameter parity or disparity, tissue sculpting, retention and resistance forms, interocclusal space, and gingival phenotype. Careful consideration of these factors will promote gingival health around a restoration, enhance esthetics, preclude food entrapment, and facilitate oral hygiene for the patient.