In implant upgrading we know two different ways of attaching the crown:

1. The abutment is first screwed into the implant and the crown is later cemented to it. Cemented crown to impant.

2. The abutment is a part of the crown and is screwed as one to the implant. Screwed crown to implant.

While cementing the crowns to the implants, there can be some cement leaking under the gum. Sometimes it cannot be removed entirely, that is why it irritates the gum and consequently causes adjacent tissue inflammation. he cement at the contact of the crown and abutment can also disolve gradually, which means that a small crack appears and can cause adjacent tissue inflammation.

With screwed crowns we don’t need to use cement, so no cement-connected inflammation takes place.

In certain cases the screwed method cannot be chosen, that is when we need to use the cementing method (an unappropriate angle of the implant, the opening for the screw on the visible tooth surface etc.).

Cemented crown (inflammation as a result of cement leak)

Screwed crown (no inflammation since cement is not needed)

We know two types of abutments – premade, that can be bought and individual that can be made by size.

The advantage of individual abutments is that each of them is adjusted to the shape of your gum and is in comparison to premade abutments more fitting. The consequence is quicker gum adaptation, that is why inflammation is rare. Better fitting of individual abutments means slower gum recession in the long run, less inflammation, less bone loss and consequently also a longer implant life span.

Premade abutment  (left) and individual abutment (right)

Possible consequences, seen right after: If the gum around the implant is thin, the metal abutment can be seen through it. The gum looks grey. With zirconium abutments there is no grey coloured gum.
Possible consequences, seen after some years: After the gum recedes or it’s level lowers, the edge of the abutment can be seen. The edge is of a dark grey colour in metal abutments. We barely notice the white edge in zirconium abutments.

Zirconium abutments have good strength, better aesthetics and biocompatibility in
comparison to the metal ones.

In the majority of problems with adjacent tissue inflammation (gum and bone) the crown and abutment have to be removed, the extent of the inflammation has to be determined and the problems eliminated by laser or surgically.

1.) If the crown is cemented to the implant, it can often be destroyed during it’s removal. In this case the same crown cannot be used again and a new crown has to be made.

2.) Crowns that are screwed to the implant, can be simply unscrewed when bigger problems occur, the problems eliminated and the existing crown replaced.

After implant placing there have to be regular check-ups at the dentist’s, because it often occurs, that the patient doesn’t feel the problems (inflammation around the implant).

Gum inflammation around the implant is called peri implant mucositis, if the inflammation spreads and it comes to bone loss, we are talking about periimplantitis.

Healthy tissue sorrounding the implant

Peri implant mucozstis (gum inflammation sorrounding the implant)

Periimplantitis (gum inflammation and bone loss sorrounding the implant)

Gum inflammation has to be treated in order to prevent implant loss.

The treatment of periimplant mucositis includes:

1. Improving everyday hygiene (flossing and use of interdental brushes etc.)
2. A visit to the oral hygienist ( the use of plastic ultrasonic points, special cuarettes etc.).

Periimplantitis treatment includes:

1. Improving everyday hygiene (flossing and use of interdental brushes etc.)
2. A visit to the oral hygienist ( the use of plastic ultrasonic points, special cuarettes etc.).
3. laser treatment,
4. surgical treatment.

What do we have to know about laser periimplantitis treatment?

For effective laser periimplantitis treatment we need two types of lasers:

1. a soft and hard tissue laser – Er:YAG
2. a soft tissue laser – Nd:YAG.

1. With the laser Er:YAG:

2. With the laser Nd:YAG:

With the Nd:YAG laser we cannot completely remove the infected bone and clean the implant surface, because we would damage it.
That is why Er:YAG is necessary for effective treatment.
The best periimplantitis treatment outcomes are expected aftet a combination of surgical and Er:YAG in Nd:YAG laser procedures.

The review of all the steps before the procedure until after it. The results are two individual zirconium abutments that were screwed to the implants together with the crown.

Before the surgical procedure: we had to extract the lower right molar.	After the surgical procedure. The teeth were replaced by two implants.
We insert gum shapers into the implants to shape the gum.	We removed a bit of the overgrown gum around the implants by Er:YAG laser.
2 days after the procedure. The gum is healing.	7 days after the procedure. The gum has healed.
CAD-CAM model of the zirconium framework.	Zirconium framework on the model.
Framework fitting.	CAD-CAM model of finished crowns
Finished crowns on model.	We screw the finished crowns to the implants.
We close the screw openings with white fillings.