Delivery of the Definitive Abutment/Prosthesis: Biologics, Aesthetics, and Mechanical Considerations

  • Chandur P. K. Wadhwani
  • Luigi Canullo
  • Todd R. Schoenbaum


The aim of implant therapy is integration, not only host tissue integration but also in the form of biology, esthetics, and mechanics, whereby the implant works as a system in harmony with the human body. Research inspired, this chapter will evaluate the fundamentals of soft tissue integration, the seal that protects the bone and acts as a barrier to the oral environment. Written by practicing clinicians, the goal is to provide information on how to optimize health through understanding handling, cleaning, aesthetics, and mechanics of the restorative componentry.


Implants aesthetic zone Abutment Cementation Microbiology 


  1. 1.
    Canullo L, Micarelli C, Iannello G. Microscopical and chemical surface characterization of the gingival portion and connection of an internal hexagon abutment before and after different technical stages of preparation. Clin Oral Implants Res. 2013;24(6):606–11.CrossRefGoogle Scholar
  2. 2.
    Canullo L, Gotz W, Cassinelli C, Tarnow D. Cell growth on titanium disks treated by plasma of argon. Int J Oral Maxillofac Implants. 2013;28:957–62.CrossRefGoogle Scholar
  3. 3.
    Canullo L, Micarelli C, Iannello G. Microscopical and chemical surface characterization of the gingival portion and connection of an internal hexagon abutment before and after different technical stages of preparation. Clin Oral Implants Res. 2013;24(6):606–11.CrossRefGoogle Scholar
  4. 4.
    Canullo L, Tallarico M, Peñarrocha-Oltra D, Monje A, Wang HL, Peñarrocha-Diago M. Implant abutment cleaning by plasma of argon: 5-year follow-up of a randomized controlled trial. J Periodontol. 2016;87(4):434–42.CrossRefGoogle Scholar
  5. 5.
    Da Silva JD, Kazimiroff J, Papas A, Curro FA, Thompson VP, Vena DA, Wu H, Collie D, Craig RG, Practitioners Engaged in Applied Research and Learning (Pearl) Network Group. Outcomes of implants and restorations placed in general dental practices: a retrospective study by the practitioners engaged in applied research and learning (PEARL) network. J Am Dent Assoc. 2014;145(7):704–13.CrossRefGoogle Scholar
  6. 6.
    Dawson DV, Drake DR, Hill JR, Brogden KA, Fischer CL, Wertz PW. Organization, barrier function and antimicrobial lipids of the oral mucosa. Int J Cosmet Sci. 2013;35(3):220–3.CrossRefGoogle Scholar
  7. 7.
    Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16(6):639–44.CrossRefGoogle Scholar
  8. 8.
    Garcia B, Camacho F, Peñarrocha D, Tallarico M, Perez S, Canullo L. Influence of plasma cleaning procedure on the interaction between soft tissue and abutments: a randomized controlled histologic study. Clin Oral Implants Res. 2017;28(10):1269–77.CrossRefGoogle Scholar
  9. 9.
    Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent. 1997;77(1):28–35.CrossRefGoogle Scholar
  10. 10.
    Kasemo B, Lausmaaa J. Material-tissue interfaces: the role of surface properties and processes. Environ Health Perspect. 1994;102(Suppl 5):41–5.CrossRefGoogle Scholar
  11. 11.
    Kelly JR, Rungruanganunt P. Fatigue behavior of computer-aided design/computer-assisted manufacture ceramic abutments as a function of design and ceramics processing. Int J Oral Maxillofac Implants. 2016;31(3):601–9.CrossRefGoogle Scholar
  12. 12.
    Lim HP, Lee KM, Koh YI, Park SW. Allergic contact stomatitis caused by a titanium nitride-coated implant abutment: a clinical report. J Prosthet Dent. 2012;108(4):209–13.CrossRefGoogle Scholar
  13. 13.
    Liu CM, Huang FM, Yang LC, Chou LS, Chou MY, Chang YC. Cytotoxic effects of gingival retraction cords on human gingival fibroblasts in vitro. J Oral Rehabil. 2004;31(4):368–72.CrossRefGoogle Scholar
  14. 14.
    Mansour A, Ercoli C, Graser G, Tallents R, Moss M. Comparative evaluation of casting retention using the ITI solid abutment with six cements. Clin Oral Implants Res. 2002;13(4):343–8.CrossRefGoogle Scholar
  15. 15.
    Millen C, Brägger U, Wittneben JG. Influence of prosthesis type and retention mechanism on complications with fixed implant-supported prostheses: a systematic review applying multivariate analyses. Int J Oral Maxillofac Implants. 2015;30(1):110–24.CrossRefGoogle Scholar
  16. 16.
    Mishra PK, Wu W, Rozo C, Hallab NJ, Benevenia J, Gause WC. Micrometer-sized titanium particles can induce potent Th2-type responses through TLR4-independent pathways. J Immunol. 2011;187(12):6491–8.CrossRefGoogle Scholar
  17. 17.
    Moisan M, Barbeau J, Crevier MC, Pelletier J, Philip N, Saoudi N. Plasma sterilization. Methods and mechanisms. Pure Appl Chem. 2002;74:349–58.CrossRefGoogle Scholar
  18. 18.
    Moráguez OD, Belser UC. The use of polytetrafluoroethylene tape for the management of screw access channels in implant-supported prostheses. J Prosthet Dent. 2010;103(3):189–91.CrossRefGoogle Scholar
  19. 19.
    Sailer I, Mühlemann S, Zwahlen M, Hämmerle CH, Schneider D. Cemented and screw-retained implant reconstructions: a systematic review of the survival and complication rates. Clin Oral Implants Res. 2012;23(Suppl 6):163–201.CrossRefGoogle Scholar
  20. 20.
    Ntrouka VI, Slot DE, Louropoulou A, Van der Weijden F. The effect of chemotherapeutic agents on contaminated titanium surfaces: a systematic review. Clin Oral Implants Res. 2011;22(7):681–90.CrossRefGoogle Scholar
  21. 21.
    Sheets JL, Wilcox C, Wilwerding T. Cement selection for cement-retained crown technique with dental implants. J Prosthodont. 2008;17(2):92–6.CrossRefGoogle Scholar
  22. 22.
    Squier RS, Agar JR, Duncan JP, Taylor TD. Retentiveness of dental cements used with metallic implant components. Int J Oral Maxillofac Implants. 2001;16(6):793–8.PubMedGoogle Scholar
  23. 23.
    Sawase T, Wennerberg A, Hallgren C, Albrektsson T, Baba K. Chemical and topographical surface analysis of five different implant abutments. Clin Oral Implants Res. 2000;11(1):44–50.CrossRefGoogle Scholar
  24. 24.
    Tarica DY, Alvarado VM, Truong ST. Survey of United States dental schools on cementation protocols for implant crown restorations. J Prosthet Dent. 2010;103(2):68–79.CrossRefGoogle Scholar
  25. 25.
    Taylor TD, Agar JR. Twenty years of progress in implant prosthodontics. J Prosthet Dent. 2002;88(1):89–95.CrossRefGoogle Scholar
  26. 26.
    van Hove RP, Sierevelt IN, van Royen BJ, Nolte PA. Titanium-nitride coating of orthopaedic implants: a review of the literature. Biomed Res Int. 2015;2015:485975.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Varthis S, Randi A, Tarnow DP. Prevalence of interproximal open contacts between single-implant restorations and adjacent teeth. Int J Oral Maxillofac Implants. 2016;31(5):1089–92.CrossRefGoogle Scholar
  28. 28.
    Wadhwani CP, O’Brien R, Kattadiyil MT, Chung KH. Laboratory technique for coloring titanium abutments to improve esthetics. J Prosthet Dent. 2016;115(4):409–11.CrossRefGoogle Scholar
  29. 29.
    Wadhwani C, Chung KH. In-office technique for selectively etching titanium abutments to improve bonding for interim implant prostheses. J Prosthet Dent. 2016;115(3):271–3.CrossRefGoogle Scholar
  30. 30.
    Wadhwani C, Hess T, Pineyro A, Chung KH. Effects of abutment and screw access channel modification on dislodgement of cement-retained implant-supported restorations. Int J Prosthodont. 2013;26(1):54–6.CrossRefGoogle Scholar
  31. 31.
    Wadhwani C, Chung KH. Effect of modifying the screw access channels of zirconia implant abutment on the cement flow pattern and retention of zirconia restorations. J Prosthet Dent. 2014;112(1):45–50.CrossRefGoogle Scholar
  32. 32.
    Wadhwani C, Hess T, Piñeyro A, Opler R, Chung KH. Cement application techniques in luting implant-supported crowns: a quantitative and qualitative survey. Int J Oral Maxillofac Implants. 2012;27(4):859–64.PubMedGoogle Scholar
  33. 33.
    Wadhwani C, Goodwin S, Chung KH. Cementing an implant crown: a novel measurement system using computational fluid dynamics approach. Clin Implant Dent Relat Res. 2016;18(1):97–106.CrossRefGoogle Scholar
  34. 34.
    Wadhwani C, Piñeyro A, Hess T, Zhang H, Chung KH. Effect of implant abutment modification on the extrusion of excess cement at the crown-abutment margin for cement-retained implant restorations. Int J Oral Maxillofac Implants. 2011;26(6):1241–6.PubMedGoogle Scholar
  35. 35.
    Wadhwani C, Piñeyro A, Avots J. An esthetic solution to the screw-retained implant restoration: introduction to the implant crown adhesive plug: clinical report. J Esthet Restor Dent. 2011;23(3):138–43.CrossRefGoogle Scholar
  36. 36.
    Weber HP, Kim DM, Ng MW, Hwang JW, Fiorellini JP. Peri-implant soft-tissue health surrounding cement- and screw-retained implant restorations: a multi-center, 3-year prospective study. Clin Oral Implants Res. 2006;17(4):375–9.CrossRefGoogle Scholar
  37. 37.
    Winkler S, Ring K, Ring JD, Boberick KG. Implant screw mechanics and the settling effect: overview. J Oral Implantol. 2003;29(5):242–5.CrossRefGoogle Scholar
  38. 38.
    Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions—a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Chandur P. K. Wadhwani
    • 1
    • 2
  • Luigi Canullo
    • 3
  • Todd R. Schoenbaum
    • 4
  1. 1.Department of Restorative DentistryUniversity of WashingtonSeattleUSA
  2. 2.Loma Linda University School of DentistryLoma LindaUSA
  3. 3.University of ValenciaValenciaSpain
  4. 4.Division of Constitutive and Regenerative SciencesUniversity of CaliforniaLos AngelesUSA

Personalised recommendations