In areas where esthetics is paramount, healing should be adequately completed around the implant healing abutment to stabilize the gingival margin before crown fabrication. This article describes a technique to increase the height of the healing abutment with laser welding when an implant is placed deep with thick overlying soft tissue.
Healing abutments are the screws placed after second-stage surgery and before insertion of prosthesis. They are available in different lengths and project through the soft tissue into the oral cavity. They may be screwed directly into the fixture or, in some systems, onto the abutment during second-stage surgery.1
When esthetics is paramount, healing should be adequately completed around the healing abutment to stabilize the gingival margin before crown fabrication. Healing abutments of appropriate length are then selected to ensure that the metal porcelain interface of the restoration will be situated subgingivally.1 In some clinical instances, there is a need to place the implant deep subgingivally due to bone availability.2 Particularly in patients with cleft palate and patients with severe bone resorption, the overlying soft tissue may be too thick to be transversed by standard length healing abutment. This situation could result in an uncomfortable condition for the patient and a difficult management issue for the implant surgeon. Moreover, the prosthetic phase may be extended due to irregular soft tissue contours preventing impression procedures (Figure 1). Multiple problems occur when the clinician does not have enough healing abutment height options.
This article describes a simple technique to increase the height of the healing abutment with laser welding when an implant is placed deep with thick overlying soft tissue. The advantages of this procedure are that a taller healing abutment can be provided in a short amount of time; thus, the technique may accelerate the prosthetic phase and provide comfort and convenience to the patient for any implant system while allowing proper soft tissue healing. The technique may be useful for clinicians who have access to one of the laser welding machines that are commonly available in many local laboratories. The requirement to extend the length of the healing abutment could have been avoided if an implant system with long enough healing abutments or modified regular abutments had been chosen for these types of cases.
1. Check the interocclusal distance between the free gingival margin and implant platform, and the free gingival margin and the opposing tooth with a periodontal probe.
2. Choose 2 appropriate-length healing abutments (Astra Tech AB; Gothenburg, Sweden) with the same width, which, when laser welded together, do not infringe upon the interocclusal distance (Figures 2 and 3).
3. Screw the healing abutments on proper analogues (Astra Tech AB) to ease handling during cutting and welding procedures.
4. Flatten the top surface of the primary healing abutment with appropriate burs, if necessary.
5. Cut part of the required height from the top of the secondary healing abutment with appropriate disks. This sectioned small part will be placed on top of the primary abutment during laser welding (Figure 4).
6. Laser-weld the small part that was split from the secondary healing abutment onto the primary healing abutment (Figures 5 and 6).
7. Polish the welded surface with appropriate burs in order to obtain a smooth soft tissue surface. Carborundum disks and stones of varying degrees of coarseness can be used first; these are followed by garnet paper and sandpaper disks, rubber points, and white Arkansas stone, and rubber wheels.
8. Screw the new long healing abutment on the implant and follow prosthetic procedures after adequate healing (Figure 7).
The authors thank Andrea Company and Andy Stevenson for their valuable contribution to this manuscript.