ABUTMENT

By Dr. MANAL RAFIE

LECTURER, Crown &Bridge department MINIA University

Abutment is the natural tooth or root which will carry the retainers of the bridge

The superstructure which is connected to the implant body and carry the final restoration

The function of the abutment is to transmit the occlusal forces falling on it to the periodontium.
Act as an anchors for the bridge.

Ideal abutment should fulfill certain requirements : 1- provides adequate retention and resistance to the restoration without scarifying much of tooth tissues.( needs less tooth reduction) 2- Has a proper C/R ratio and healthy periodontal support.

3- Should has a good axial inclination. Teeth with more than 25are contraindicated for fixed prosthodontics.

4- With vital pulp. The size of the pulp may alter the type of retainer. 5- Esthetics can be achieved easily.

Not always the teeth available for selection are of favorable condition. Questionable abutment is that tooth which does not fulfill one or more of the previous requirements.

Factors affecting selection of Abutments

1-Coronal Portion: A- Form of the coronal portion: conically shaped, peg shaped are indicated for c.c. restoration. B-Size: short or excessively constricted teeth are

contraindicated for fixed restoration unless certain

precautions are taken. C- Alignment: Rotated & tilted teeth will be subjected to

removal of tissues from parts more than others(non

uniform reduction).

d-Location:Abutments in a curved path(long span bridge)

must resist MD.&BL. Movements(forces)

while

abutments in straight line resist MD. Forces only . The order in preference for teeth as abutments is:U&L 6

THEN U&L 3 then U&L 7 U4,5 &L 4,5 &U1.

E-CARIES& EXISTING restorations may alter the type of indicated retainer.

I- Abutment of inadequate amount of sound tooth structure: a) Peg shaped lateral incisor .it is indicated for complete coverage restoration.

b) Large sized pulp .partial coverage rather than complete coverage

Normal Pulp

Large Pulp

Tooth preparation can not be performed without endangering pulp vitality

F) Teeth with constricted necks , intentional endodontic treatment followed by crown.

Amelogensis imperfecta With severe wear in posterior teeth

Dentinogensis imperfecta

Malformed

teeth.

Before

After

D) Carious teeth with very little amount of sound structure

The clinical approaches to uncontrolled caries are: Prophylaxis and fluoride treatments. Dietary consultation Operative dentistry and endodontic consulation Periodontal treatment if needed. Complete coverage restoration.

2-Crown/Root ratio: it is a linear measurement of

part of the tooth incisal to alveolar bone to that embedded in it. The ideal ratio is 2/3,1/1 may be accepted providing no mobility.

-Abutments with questionable C/R ratio a- Bone resorption b- Over eruption c- Soft tissue hyperplasia d- Attrition E- gingival recession.
Teeth that associated with pathological lesion and need apicectomy

gingival hyperplasia

Gross gingival hyperplasia and enamel hypoplasia

The Hyperplastic gingival tissue has been removed

Crowns on the upper incisor teeth for the same patient

Abutments with questionable C/R ratio: Bone resorption violate C/R ratio

Teeth associated with pathological lesion which need apicectomy, hemisectioning or surgical extraction

ROOT CONFIGURATION: and oval cross section root is more stable than circular ,diverge roots more preferred than fused one.

OCCLUSION
Any abnormality in the alignment of the abutment means mal-occlusion,which affects the type of the retainer as well as the amount of reduction. Premature contact will induce more than average

stress on the bridge , which needs increasing the

number of abutments Natural opposing teeth exert forces of about 150Ib

OPPOSING fixed p.d. exert 54Ib ,& removable

partial denture exerts 26Ib.

Malaligned Abutments
1-MESIALY INCLINED MOLAR

2-ROTATED TOOTH
3-SUPRAERUPTED TOOTH

Normal alignment

Mal-alignment

This fixed partial denture will not seat because the tooth distal to the fixed partial denture intrudes on the path of insertion

Orthodontic appliance for up righting a tilted molar

Fixed partial denture using a proximal half crown as a retainer on a tilted molar abutment

Fixed partial denture using a telescope crown and coping as a retainer on a tilted molar abutment.

A nonrigid connector on the distal aspect of the premolar retainer compensates for the inclination of the tilted molar.

Malposed or rotated teeth.

Span length
The span length or the no. of missing teeth affects the no. of used abutments in the bridge. The degree of deflection of a bridge is directly proportional to the no. of missing teeth ( cube of span length) Fixed partial denture will bends one time if one tooth is missing ,while it bends 8 times if two teeth are missing. In case of long span bridge , we must take a secondary abutments which should not be weak or badly decayed or endodonticaly treated but has the nearly same strength as the principle abutments.

There is one unit of deflection (X) for a given span length (p)

The deflection will be 8 times as great (8X) if the span length is doubled (2p).

The deflection of a fixed partial denture is proportional to the cube of the length of its span.
A, A single pontic will deflect a small amount (D) when subjected to a certain force (F). B, Two pontics will deflect 23 times as much (8 D) to the same force C, Three pontics will deflect 33 times as much (27 D).

Periodontium
The periodontal membrane area of the abutments must be equal or more than the missing teeth. Larger teeth have larger surface area that make them more capable to withstand added stress (Antys Law)

Any mobility in the abutment means additional abutments to be used (secondary abutment)

Splinting: uniting teeth together with rigid connectors is

another solution.

Congenital defects
Cleft palate(mobile central incisors with bone loss)
The preoperative condition following surgical treatment

The prepared teeth. Two abutments in each buccal segment are used together with the two teeth in the pre maxilla

The completed bridge stabilizing the pre maxilla

Spring cantilever bridge Abutments are remote from the edentulous span ( this is an old type of bridge and rarely used now) Cantilever bridge , never use lateral incisors nor endodonticaly treated teeth as abutments for cantilever bridge.

Pier Abutment
Definition: it is that tooth with edentulous space mesial & distal to it. Teeth in anterior segment move in facio-lingual direction, while in posterior segment the teeth tend to move in mesio-distal direction. A five units bridge with upper canine as pier abutment is an example of a bridge subjected to complex forces A rigid fixed-fixed bridge is less than ideal solution. Because it will tend to exert much forces on this pier abutment.

The solution is fixed removable bridge(a bridge with non rigid connector on the distal side of the retainer)

If a nonrigid connector is placed on the distal side of the retainer on a middle abutment, movement in a mesial direction will seat the key into the keyway

If a nonrigid connector is placed on the mesial side of the middle abutment, mesially directed movement will unseat the key.

Complex Bridge (Missing Canine):

If the bridge crosses the canine line, it is known as complex bridge as in case of missing canine taking 1,2 and 4 as abutments.

The problem is obtaining a common path of insertion between anterior teeth inclined in fronto-axial direction 1 and 2 and posterior teeth parallel to this long axis (4) this needs severe reduction on the labial surface of anterior teeth.

Missing 3

Solutions:
Implant. .1 Fixed fixed bridge on 1,2 & 4. .2 The bridge will move labially leaving on .3 open contact distal to the 4 so we use 5 or 1 as an added abutment and the 1 is preferred not to end the bridge on weak abutment. Fixed fixed bridge 2 & 4 only if the .4 opposing is partial or complete denture. Fixed free bridge (cantilever) on 5, 4. .5 Use partial coverage retainers for the anterior teeth with no reduction for the labial surface.

Missing 3
1. Implant 2. Fixed fixed bridge on 4 & 2 (use 1 or 5 as added abutment)

THANK YOU