Issues with the ti base implant abutment

Ti base implant abutments are great in the right case when we use the right size and we use proper bonding protocols.

What are some of the issues with ti bases?

They can come apart. That is the biggest issue by far. Whether they break or the cement breaks or the crown itself breaks is somewhat irrelevant to the fact that these issues are not seen with a standard implant abutment or the hybrid abutment.

Improper or poor bonding technique.

This is impossible to know about the fact but most failures probably have some component of improper bonding.

Poor design of the crown or poor positioning.

If the crown has a cantilever, then we are asking far more of the bonding of the ti base to the crown. We are also asking more of the thin layer of material that may be around the ti base. This tooth has a wide mesial cantilever that was too much pressure for the thin zirconia covering the ti abutment.

Fracture of the ti base

Fracture of a ti base is not as common as some of the other issues. This really isn’t a ti base problem as much as a “well something will break eventually” problem. Frankly the ti base breaking is a lot better than an implant breaking. A ti base breaking is about the same as a standard abutment breaking, which is to say it can happen.

Too short of a Ti base and poor design.

The height of the Ti base has a big impact on how secure it is with the crown. Ideally we want 4mm ti base. The short 2mm ti bases are more prone to separation. Poovarodom JPD 2023 finds that small ti bases increase the risk of fracture of the zirconia abutments. To be clear we are talking about height of the portion of the ti base that lutes to the crown. The height of the ti base from the screw to the base should be a minimum of 2mm to help eliminate bone loss. A general rule is the deeper the implant the higher the platform on the ti base should be.

Friction fit ti bases.

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 has 1mm of metal friction fit into the zirconia portion. Ideally we want 4mm of height for the ti base.

A far superior design for a ti base is below. Notice a significant higher ti base for better retention.

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