What exactly is a "custom abutment" for an implant crown...
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From: JimSocal on 23 Jun 2008 04:35 .... and when is it necessary to have one?
From: Richard on 26 Jun 2008 08:33 A custom abutment is a part that is machined out of a block of titanium which fits into the implant and a crown is made over it. Some doctors or laboratories use them for all of their cases, some use modified stock abutments. I have never used them. For more info: http://www.atlantiscomp.com/ JimSocal wrote: > ... and when is it necessary to have one?
From: Mark & Steven Bornfeld on 26 Jun 2008 11:06 Richard wrote: > A custom abutment is a part that is machined out of a block of titanium > which fits into the implant and a crown is made over it. Some doctors or > laboratories use them for all of their cases, some use modified stock > abutments. I have never used them. For more info: > http://www.atlantiscomp.com/ > > JimSocal wrote: >> ... and when is it necessary to have one? This looks like an interesting technology, but most custom abutments are not milled by a CAD-CAM technology--they are custom cast, usually in gold alloy (there is a titanium understructure that screws into the implant fixture. They are generally used when the placement of the implant fixture is such that it is not possible to place a functional, esthetic crown using a stock (pre-made) abutment. Of course, occasionally fixtures are placed such that it's impossible to put a crown or attachment in a good clinical position. That's why collaboration between the surgeon and restorative dentist is so important. Steve -- Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
From: JimSocal on 2 Jul 2008 15:13 On Thu, 26 Jun 2008 15:06:52 GMT, Mark & Steven Bornfeld <bornfeldmung(a)dentaltwins.com> wrote: >Richard wrote: >> A custom abutment is a part that is machined out of a block of titanium >> which fits into the implant and a crown is made over it. Some doctors or >> laboratories use them for all of their cases, some use modified stock >> abutments. I have never used them. For more info: >> http://www.atlantiscomp.com/ >> >> JimSocal wrote: >>> ... and when is it necessary to have one? > > > > This looks like an interesting technology, but most custom abutments >are not milled by a CAD-CAM technology--they are custom cast, usually >in gold alloy (there is a titanium understructure that screws into the >implant fixture. > They are generally used when the placement of the implant fixture is >such that it is not possible to place a functional, esthetic crown using >a stock (pre-made) abutment. Of course, occasionally fixtures are >placed such that it's impossible to put a crown or attachment in a good >clinical position. That's why collaboration between the surgeon and >restorative dentist is so important. > >Steve Thank you Richard and Dr. Bornfeld for your answers. This is what my student dentist told me (I got an email back from her after your replies; this work was done about a year ago): "custom abutments are not required, stock abutments could have been used, but in my experience results are better with custom abutments especially when multiple implants are used as in your case. Some form of abutment has to be used otherwise the PFM (crown) can not be placed, since it is the connector between the implant screw and crown. I'm not sure why your original treatment plan did not include the custom abutments, it might have been that at the time of your original treatment plan the University did not charge for abutments." ------------------------------------------------------- By the way, if her last comment is the case, then I think the prices on my treatment plan should be honored. This is why I am asking the question: I had a Treatment Plan for 4 implant crowns and it called for 6 implant crowns at $850 each. [2 had not yet been done at the time of this bill). This is what I agreed to and I was never told anything different was going to be done or that any expenses were being added. So when I got my bill, I saw that I was charged $675 for the Implant crowns, high noble - but also 4 x $650 for "Implant Custom Abutments". So that is $2600 more than what I was told I'd be charged, and no one dicussed this with me! (??!!) (Granted, the PFM's were $175 less each so that offsets some of the difference, but still that leaves a $1900 difference added.) So I am in the process of contesting this on the grounds that I was never told they would be needed. Would it not be standard practice to tell a patient if an extra $2600 was going to be added to his bill? especially if he has a signed treatment plan that does not call for custom abutments? I think at the very least they should compromise with me and charge me LESS for the custom abutments. What do you think? And maybe you can help me out here - if I paid $650 per crown and $675 per custom abutment (remember, this is at a dental school, so I should get it cheaper - I had to endure many more appt's than necessary for their lack of competence and many more hours in the chair for the same reason plus they are learning on me), how much room is there for them to discount this any further to allow for any money back due to their having not told me about it? I'm willing to compromise as I understand it may have just been an oversight, but still I don't think it's right to expect a person to pay $1900 more than their treatment plan called for without having told them. And finally, what would be an average ballpark price for custom abutments per crown at a dental office? Comments? Opinions?
From: Mark & Steven Bornfeld on 2 Jul 2008 15:36
JimSocal wrote: > On Thu, 26 Jun 2008 15:06:52 GMT, Mark & Steven Bornfeld > <bornfeldmung(a)dentaltwins.com> wrote: > >> Richard wrote: >>> A custom abutment is a part that is machined out of a block of titanium >>> which fits into the implant and a crown is made over it. Some doctors or >>> laboratories use them for all of their cases, some use modified stock >>> abutments. I have never used them. For more info: >>> http://www.atlantiscomp.com/ >>> >>> JimSocal wrote: >>>> ... and when is it necessary to have one? >> >> >> This looks like an interesting technology, but most custom abutments >> are not milled by a CAD-CAM technology--they are custom cast, usually >> in gold alloy (there is a titanium understructure that screws into the >> implant fixture. >> They are generally used when the placement of the implant fixture is >> such that it is not possible to place a functional, esthetic crown using >> a stock (pre-made) abutment. Of course, occasionally fixtures are >> placed such that it's impossible to put a crown or attachment in a good >> clinical position. That's why collaboration between the surgeon and >> restorative dentist is so important. >> >> Steve > > Thank you Richard and Dr. Bornfeld for your answers. > > This is what my student dentist told me (I got an email back from her > after your replies; this work was done about a year ago): > > "custom abutments are not required, stock abutments could have been > used, but in my experience results are better with custom abutments > especially when multiple implants are used as in your case. Some form > of abutment has to be used otherwise the PFM (crown) can not be > placed, since it is the connector between the implant screw and crown. > > I'm not sure why your original treatment plan did not include the > custom abutments, it might have been that at the time of your original > treatment plan the University did not charge for abutments." > ------------------------------------------------------- > By the way, if her last comment is the case, then I think the prices > on my treatment plan should be honored. > > This is why I am asking the question: > I had a Treatment Plan for 4 implant crowns and it called for 6 > implant crowns at $850 each. [2 had not yet been done at the time of > this bill). This is what I agreed to and I was never told anything > different was going to be done or that any expenses were being added. > > So when I got my bill, I saw that I was charged $675 for the Implant > crowns, high noble - but also 4 x $650 for "Implant Custom Abutments". > > So that is $2600 more than what I was told I'd be charged, and no one > dicussed this with me! (??!!) > > (Granted, the PFM's were $175 less each so that offsets some of the > difference, but still that leaves a $1900 difference added.) > > So I am in the process of contesting this on the grounds that I was > never told they would be needed. > > Would it not be standard practice to tell a patient if an extra $2600 > was going to be added to his bill? especially if he has a signed > treatment plan that does not call for custom abutments? > > I think at the very least they should compromise with me and charge me > LESS for the custom abutments. > > What do you think? > > And maybe you can help me out here - if I paid $650 per crown and $675 > per custom abutment (remember, this is at a dental school, so I should > get it cheaper - I had to endure many more appt's than necessary for > their lack of competence and many more hours in the chair for the same > reason plus they are learning on me), how much room is there for them > to discount this any further to allow for any money back due to their > having not told me about it? > > I'm willing to compromise as I understand it may have just been an > oversight, but still I don't think it's right to expect a person to > pay $1900 more than their treatment plan called for without having > told them. > > And finally, what would be an average ballpark price for custom > abutments per crown at a dental office? > > Comments? Opinions? I've done custom abutments where the lab fee is over $600. There should be some profit margin, but ordinarily I don't think it needs to be much, as it's basically nuts and bolts. But the materials charges are high, and the tools required are expensive. You are asking a question that really is contract law. I'm guessing that you must have signed some kind of consent or contract. If so, the fee estimate should be spelled out (with reasonable provisions for unanticipated changes). IMO the need for abutments should be explained to the patient, but in my experience some patients remember, and some don't. I have no idea about the legal issues, so I can't help you there. Steve -- Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |