Dental implant Hybrid abutment is also known as the H abutment
Hybrid abutment is an abutment with a titanium section that is against the dental implant and a ceramic section over it to hide the metal. The H abutment is often specifically a lithium disilicate sleeve that the lab lutes to the titanium base.
Hybrid abutment IDT 2012 Vol 3 Issue 6 – a Ti-Zi or Ti-emax hybrid. 3M and several other companies manufacture different versions, but I feel the custom hybrid abutments that the labs make are the best.
Ideal custom abutment…
- The same shape as the natural tooth at the original gumline. That is rectangular for anteriors, oval for canines and premolars and rectangular for molars.
- The emergence profile is trumpet shaped.
- Margin is at or slightly below gingiva on facial
- Margin slightly above gingiva IP and on lingual
- The height of the abutment is more than 2mm. Chen JPD 2019
There is a balancing act when it comes to how smooth the abutment should be. Extremely smooth abutments appear to reduce bacterial colonization they also reduce adherence of fibroblasts. Titanium is better at least at the interface. The height should be as tall as possible and preferably more than 2mm. Internal conical (Morse taper0 and internal hex have the least microleakage. The abutment needs to create an environment where the resulting crown does not convex uncleansable surfaces. Mahn 2019 Compendium
The H abutment is an abutment consisting of emax sleeve that we lute to a Ti abutment IDT 2013 Feb
- Ti base and chimney (4mm and emax part no more than 2x chimney height) sandblast 50 um
- Universal primer like Monobond Plus
- Custom stained Emax abutment – HF etch and Monobond Plus
- Opaque shade of LC cement extra oral
- Clean, HF, phosphoric etch, silane, bond, emax abutment and emax crown
Why need at least 4mm for hybrid implant abutment?
This dental implant restoration developed inflammation circumferentially after about 6 years. Upon removal it was discovered the metal and zirconia had separated. This design only had 1mm of metal friction fitted into the zirconia portion.
Far superior design to the above.
3M (far right) tests better than other hybrid style abutments (IMHO its’ because you have Ti-Ti as an implant-abutment interface) Kim April 2013 JPD
Why do you not use pure zirconia abutments?
Pure zirconia for a dental implant abutment is not a good idea for two main reasons. First of all the abutment is more likely to fracture. The second is that the two materials will wear against each other and will damage the internal aspect of the dental implant.
Zirconia abutment damages the internal aspect of the dental implant more than titanium abutment. Gehrke JPD 2016
Material Research IJOMI=The highest fracture resistance was obtained with titanium abutments restored with emax crowns. This study is also in JADA
Hybrid abutment with porcelain stacked on titanium
Design of a custom abutment
Everyone has their favorite design or way of doing this. I like the chart below to show how want the custom abutment to look, although most companies have very similar things for dentists to use. Some of this will be influenced by how your custom healing abutment looks.