Back when I first started practicing, Implant dentistry was primitive. Many of the technologies we enjoy today weren’t even on the drawing board. At that time, dental implants were placed by Periodontists and Oral Surgeons. Different systems were used by different surgeons. This created some frustration for restoring dentists as they had to be tooled up and proficient with different systems. Frequently that meant borrowing tools and parts from the surgeons, who rarely got them back or were out on loan when someone else needed them. Another frustration for the restoring dentist was the lack of continuity of pricing between labs or even within the same lab. It was difficult to quote restorative fees in advance because the cost of parts and services from the lab was inconsistent. In some cases if a custom abutment was used unexpectedly and the dentist quoted a fee, the extra expense could quickly eat into the profits of the case.
Out of deference to the restorative dentists, I decided to take on the responsibility for the abutment. By providing a restorative abutment it simplified the restorative process. After all, now the restoration could be treated like conventional crown and bridge as no special tools were required to complete the restoration. There was no more confusion about lab fees.
I didn’t charge extra for the abutment. Although it was more expensive than the healing abutment I would normally place the goodwill generated outweighed the additional cost. This practice was widely embraced for several years.
I got very proficient with making and placing implant abutments. Early on I worked with pre fabricated parts. They came with different collar heights and in different angulations. The strategy then was to pick the part that closest approximated the situation, modify it by hand then torque it in place. The abutments weren’t anatomic so the resulting restorations often mushroomed out from the gingival aspect.
The next evolution with custom abutments came with the introduction of Nobel Procera. Not what it is today but the first generation. In this scenario implant T-bar cylinders were placed over the implants intra orally.