1. INTRODUCTION OF
HYBRID ZIRCONIA ABUTMENT
Make your life easier
2014/8/17
BOSTON UNIVE
RSITYIMPLANTTOL
OGY
DEPARTMENT
C.A.G.S2002-200
4
KYUSH
U
DENTALCOLLEG
E
OCCLUSION&MA
XILLOFACIAL
DI
VISION
TS
UNG
HAN
YANG

2. Tsung han yang DDS,CAGS,DICOI
• 中山醫學院 醫學系畢業（1999）
• 美國波士頓大學植 中心醫師（2004-2006)
• 日本九州齒科大學膺復科在職博士進修
（2008∼now)
• 美國國際植 學會最高院士
• 美國Owoc institute &briar Forrest dental
group 植 顧問
• 高雄大順 醫診所醫師
• 高雄厚安 醫植 與 周病特約醫師

3. COST OF IMPLANT PROSTHESIS RESTORATION
Depend on dentist(2xxx~1xxxxx)
Implant mount
Solid abutment,2-piece stock abutment
Screw abutment,custom abutment........
Base metal,precious metal,zirconia,biohpp

4. THE IMPORTANT COMPONENT WE OVERLOOKED
Connect to fixture
Connect to prosthesis
Contact /support soft tissue

5. UNDERSTANDYOURSELF ABILITY

6. TIMING OF IMPLANT PROSTHESIS RESTORATION

7. UNDERSTANDYOUR PATIENT

8. TOUGH DAY? BLOCK GRAFT
Might be avoided!!!

9. TOUGH DAY? SPLIT RIDGE
Might be avoided!!!

10. TOUGH DAY?
NONRESORBABLE MEMBRANE WITHTITANIUM REINFORCED
Might be avoided!!!

11. TOUGH DAY?
RESORB-ABLE COLLAGEN MEMBRANE
Might still be needed!!!

12. TOUGH DAY?
SINUS LIFT OPEN WINDOW
Can't be avoided!!!

13. 屋台 小金
福岡天神

14. WHAT HAPPEN AFTERTOOTH REMOVED

15. WHAT HAPPEN AFTERTOOTH REMOVED

16. WHAT HAPPEN AFTERTOOTH REMOVED
Before extraction 2 months later

17. IMPLANT INSERTION & PROSTHETICTYPE CONCERNED

18. PALATIAL POSITIONED

19. WHY CUSTOM ABUTMENT
Better path of insertion
No margin overhang
Better contour,emergence profile
Less food trap,better esthetic

20. WHY CUSTOM ABUTMENT
Easy to clean cement
Less inflammation
Better prosthesis retention,resistance
Less prosthesis failure
The Positive Relationship Between Excess Cement and Peri-Implant Disease:A Prospective Clinical Endoscopic Study
Excess dental cement was associated with signs of peri-implant disease in the majority (81%) of the cases. Clinical and endoscopic signs of peri-implant disease were absent in 74% of the test implants after the
removal of excess cement.

21. CUSTOM ABUTMENT

22. UCLA ABUTMENT
Precious metal= money
Ucla abutment=money
Lab fee=money

23. CCM ABUTMENT
CCM=Co,Cr,Mo
Orthopedic artificial joint
Base metal for casting
Biocompatibility ??
CCM abutment=less money
Lab fee=money

24. WHY NO UCLA AND CCM
ZrO2&Ti-abutment soft tissue response better than Au/Pt alloy
The mucosal barrier at implant abutments of different materials,Clin Oral Implants Res. 2008 July
CCM abutment accuracy after casting
!
The effect of casting procedures on rotational misfit in castable abutments.,Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):575-9.
!
!
!
!
!
!
!
!

25. WHY ZIRCONIA
Biocompatibility
Less bacterial adhesion
Bacterial Adhesion on Commercially Pure Titanium and Zirconium Oxide Disks:An InVivo Human Study, J Periodontol 2004;75:292-29
Better fibroblast adhesion
Effect of Roughness of Zirconia and Titanium on Fibroblast Adhesion,Artif Organs. 2008 Apr;32(4):305-9. doi: 10.1111/j.1525-1594.2008.00547.x.
Less inflammatory response compared to Ti6Al4V
Biological reaction to alumina, zirconia, titanium and polyethylene particles implanted onto murine calvaria,Biomaterials. 2003 Sep;24(21):3655-61
!

26. WHY ZIRCONIA
Esthetic(2mm rule)
The effect of zirconia and titanium implant abutments on light reflection of the supporting soft tissues,Clin Oral Implants Res. 2011 Oct;22(10):
1172-8. doi: 10.1111/j.1600-0501.2010.02082.x. Epub 2011 Jan 20.
Single-tooth implant reconstructions: esthetic factors influencing the decision between titanium and zirconia abutments in anterior regions,Eur J Esthet
Dent. 2007 Autumn;2(3):296-310.
!

27. THIN SOFTTISSUE/TI-ABUTMENT

28. THICK-SOFTTISSUE/TI-ABUTMENT

29. WHY HYBRID ZIRCONIA

30. WHY HYBRID ZIRCONIA
Ti-abutment is better in strength&reliability than full Zr-abutment
Reliability and fatigue damage modes of zirconia and titanium abutments,The International Journal of Prosthodontics [2010, 23(1):56-59]!
Ti-abutment shows better connection fit compared with Zr-abutment
Marginal accuracy of three implant-ceramic abutment configurations.The International Journal of Oral & Maxillofacial Implants [2012, 27(3):537-543]
Hybrid Zr-abutment is better than full Zr-abutment and is close
to Ti-abutment
Bending moments of zirconia and titanium abutments with internal and external implant-abutment connections after aging and chewing
simulation.Clinical Oral Implants Research .03/2011; 23(1):12-8. DOI:10.1111/j.1600-0501.2010.02141.x!
!
Survival rate, fracture strength and failure mode of ceramic implant abutments after chewing simulation,Journal of Oral Rehabilitation
Volume 32, Issue 11, pages 838–843, November 2005!
!
The Implant-Abutment Interface of Alumina and Zirconia Abutments.Clinical Implant Dentistry and Related Research.Volume 10, Issue
2, pages 113–121, May 2008!

31. 小倉城櫻花
北九州市

32. ZIRCONIA HYBRID CUSTOM ABUTMENT
ANTERIOR SINGLE CROWN

33. ZIRCONIA HYBRID CUSTOM ABUTMENT
ANTERIOR BRIDGE

34. ZIRCONIA HYBRID CUSTOM ABUTMENT
POSTERIOR SINGLE CROWN

35. ZIRCONIA HYBRID CUSTOM ABUTMENT
POSTERIOR BRIDGE

36. ZIRCONIA HYBRID CUSTOM ABUTMENT
FULL ARCH PROSTHESIS

37. ESTHETIC CASE

38. ESTHETIC CASE

39. ESTHETIC CASE

40. GINGIVAL RECESSION

41. OLD PHILOSOPHY

42. OLD PHILOSOPHY

43. OLD PHILOSOPHY
Soft tissue after one year

44. COMPARED

45. TISSUE MOLDING?
ANOTHER LONG STORY
Without tissue molding
you can't squeeze out the potential of custom abutment

46. CLINICALTIP FOR ZIRCONIA
CUSTOM ABUTMENT
Choose healing abutment at least 5mm in diameter

47. 小倉城
北九州市

48. HYBRID ZIRCONIA ANATOMY PROSTHESIS

49. HYBRID ZIRCONIA ANATOMY PROSTHESIS

50. HYBRID ZIRCONIA ANATOMY PROSTHESIS

51. THE PROS AND CONS OF HYBRID
ZIRCONIA ANATOMY PROSTHESIS
Less inflammation
More design freedom

52. THE PROS AND CONS OF HYBRID
ZIRCONIA ANATOMY PROSTHESIS

53. TROUBLE SHOOTING 1
BAD IMPLANT POSITION,SOFTTISSUE INFLAMMATION

54. TROUBLE SHOOTING 1
BAD IMPLANT POSITION,SOFTTISSUE INFLAMMATION

55. TROUBLE SHOOTING 1
BAD IMPLANT POSITION,SOFTTISSUE INFLAMMATION

56. TROUBLE SHOOTING 1
BAD IMPLANT POSITION,SOFTTISSUE INFLAMMATION

57. TROUBLE SHOOTING 2
LIMITED OCCLUSAL SPACE

58. TROUBLE SHOOTING 2
LIMITED OCCLUSAL SPACE

59. TROUBLE SHOOTING 3
SUPER LIMITED OCCLUSAL SPACE&BAD ANGULATION

60. OLD DAY ,OLD STYLE

61. OLD DAY ,OLD STYLE

62. OLD DAY ,OLD STYLE

63. OLD DAY ,OLD STYLE

64. TROUBLE SHOOTING 4
BAD IMPLANT POSITION

65. TROUBLE SHOOTING 4
BAD IMPLANT POSITION,LIMITED LINGUAL SPACE

66. TROUBLE SHOOTING 4
BAD IMPLANT POSITION

67. TROUBLE SHOOTING 4
BAD IMPLANT POSITION

68. TROUBLE SHOOTING 4
BAD IMPLANT POSITION

69. TROUBLE SHOOTING 5
BAD PALATIAL POSITIONED

70. TROUBLE SHOOTING 5
BAD PALATIAL POSITIONED

71. CLINICALTIP FOR HYBRID
ZIRCONIA ANATOMY PROSTHESIS
Seal the screw hole

72. CLINICALTIP FOR HYBRID
ZIRCONIA ANATOMY PROSTHESIS
try in

73. 唐戶市場
下關

74. HYBRID?
Ti-base
Ti-interface
Zirconia custom abutment coping
Zirconia anatomy prosthesis coping
Zirconia full contour prosthesis coping
Hybrid Zirconia custom abutment
Hybrid Zirconia anatomy prosthesis
Hybrid Zirconia full contour prosthesis

75. TI-BASE(TI-INTERFACE)

76. TI-BASE(TI-INTERFACE)

77. TI-BASE(TI-INTERFACE)

78. TI-BASE(TI-INTERFACE)

79. TI-BASE(TI-INTERFACE)

80. TI-BASE(TI-INTERFACE)

81. TI-BASE(TI-INTERFACE)
Anker ti base
Retentive groove
Anti-rotational structure

82. ZIRCONIA COPING
Quality of zirconium

83. ZIRCONIA COPING
Fitness
No cement
Friction only
(Retention) Fitness (resistance)

84. ZIRCONIA COPING
Fitness

85. COMBINE ZR-COPING WITHTI-BASE
Commercial secret
Cement
Primer
Sandblast

86. CLINICAL CONSIDERATION
HYBRID ZIRCONIA ANATOMY PROSTHESIS
AND HYBRID ZIRCONIA ABUTMENT
Zirconia loosening from titanium
base

87. CLINICAL CONSIDERATION
HYBRID ZIRCONIA ANATOMY PROSTHESIS
Implant failure,due to high
occlusion force?
Occlusal adjustment
Torque control 25n-cm

88. CLINICAL CONSIDERATION
HYBRID ZIRCONIA CUSTOM ABUTMENT
Fracture
Thickness control(0.3mm)
Temperature control during
finishing
Sintering process

89. 結束了 ？

90. 放
馬過來
Question?

91. Thanks for
your attention
Need more information
Please email
dentistyang@msn.com