Atlantis Screw Retained Zirconia Abutment

[DanM]

Dr wants an Atlantis screw-retained zirconia abutment for a PFZ. It is an EV for #9 because implant depth is shallow any ti would show. However he has concerns because his past experience (and from others I've heard) is that full zirconia abutments tend to break.
Anyone have any experience with these or thoughts on using them?

 

[2thm8kr]

Almost every abutment we have done with a zirconia interface has fractured. I think it is just a matter of time before the rest fail.
Zr is also abrasive to the titanium female interface of the implant. See about getting a Ti base for that.
I can't believe I just suggested a Ti base, hate those things.

 

[CatamountRob]

I detest the Ti bases and often times if the implant is really shallow you might as well use a full Ti abutment.
I've done some zirc abutments with Atlantis, all were either Nobel bone level or Ankylos, none of them have failed.
I've also used some stock zirc abutments from Straumann as well as their custom abutments, with good results.

 

[DanM]

Almost every abutment we have done with a zirconia interface has fractured. I think it is just a matter of time before the rest fail.
Zr is also abrasive to the titanium female interface of the implant. See about getting a Ti base for that.
I can't believe I just suggested a Ti base, hate those things.

It was this dentist that told me the same thing about the zi wearing the implant interface. Was even concerned with the small margin of the ti base showing.

 

[2thm8kr]

Looks like someone (read clinician) needs to pick the lesser of two evils here then write a script of what he wants you to do.

 

[Toothman19]

It was this dentist that told me the same thing about the zi wearing the implant interface. Was even concerned with the small margin of the ti base showing.

Anodize the TI base. it will help hide the color a bit better

 

[Car 54]

It would at least give it a more pleasing color.

On this one, I would probably go with a zirconia abutment, and just not warranty it if we're afraid of future failure.
It's what I told my accounts, I can do them, but I just won't warranty them. I do a lot of anterior UCLA abutments that I opaque the "prep", then do a emax crown.

 

[Brett Hansen CDT]

From what I have been told, zir abutments in conical implants, like astratech and strauman, do not have the abrading issue because of the internal connection design. I have done hundreds of anterior full zirconia abutments with atlantis on a variety of implant platforms going back to 2008ish. I have had zero implant failures in that time. I have had three zirconia abutments I did in the posterior region break(I would never do a zirc abutment in the posterior now) and I have had one or two zirc abutments in the anterior region break. My success rate is over 99% on my Atlantis cases. I do use Au-hued Titanium abutments in the anterior if I feel like the crown is going to be too long and possibly create too much axial force which zirconia does not handle well.

 

[dmonwaxa]

It look like the implant is a bit lingual...so a labial cantilever. I'd recommend to a but in this situation. You're gonna have to ridge lap on the manual anyway so that'll hide the abutment....crappy placement but that is where the bone was ...off course.

 

[JohnWilson]

Guys this is an EV case there are no Ti bases in the US for it. The fact that the depth is so shallow you will not even be able to cast a UCLA with out cutting back facial to layer glass in the "no no zone"

I would document/ and move forward with his requests to do the anatomical abutment and move on with business. You didn't place this fixture so stop sweating it and push for better planning.

This is an absolute perfect example of a surgeon not restoratively driven or even knowing the available restorative parts/path. Its more "leave it to the lab to figure it out planning".

Good luck it can be done.

 

[PDC]

From what I have been told, zir abutments in conical implants, like astratech and strauman, do not have the abrading issue because of the internal connection design.

My Atlantis rep stopped in earlier today and basically said the same. He also stated that Atlantis had researched the issue of broken zirc interfaces and found that most were related to improper seating, over-torqueing the screws, and a rougher surface at the zirconia interface.

About 10 or 12 months ago, they started including a positioning guide with all zirc abutments to avoid improper seating...it seems that some docs might start torqueing the abutments without them being fully seated at the bottom of the implant interface.
Atlantis has also started giving the zirconia interface a much more polished finish so that it will seat into the implant without quite so much friction.

Since making these adjustments, he stated that there have been almost no breakage problems.

Just remember, Atlantis made the abutment and designed it within FDA specs. If anybody needs to worry, it's the oral surgeon and Atlantis.

 

[Andrew Priddy]

yea.. we've never heard that from a rep... especially DENTSupPLY

 

[DanM]

Thanks for all the input!

 

[sidesh0wb0b]

Almost every abutment we have done with a zirconia interface has fractured. I think it is just a matter of time before the rest fail.
Zr is also abrasive to the titanium female interface of the implant. See about getting a Ti base for that.
I can't believe I just suggested a Ti base, hate those things.

interesting, ive done dozens maybe more....only ever had one fracture.