CLINICAL
A TECHNIQUE TO MODIFY THE LENGTH OF AN
IMPLANT HEALING ABUTMENT
Burak Yilmaz, DDS, PhD; Edwin McGlumphy, DDS, MS; Ilser Turkyilmaz, DDS, PhD
In areas where esthetics is paramount, healing should be adequately completed around the implant
healing abutment to stabilize the gingival margin before crown fabrication. This article describes a
technique to increase the height of the healing abutment with laser welding when an implant is
placed deep with thick overlying soft tissue.
Key Words: implant, healing abutment
INTRODUCTION
H
ealing abutments are the screws placed
after second-stage surgery and before
insertion of prosthesis. They are avail-
able in different lengths and project
through the soft tissue into the oral
cavity. They may be screwed directly
into the fixture or, in some systems, onto the
abutment during second-stage surgery.1
When esthetics is paramount, healing should be
adequately completed around the healing abutment
to stabilize the gingival margin before crown fabrica-
tion. Healing abutments of appropriate length are
then selected to ensure that the metal porcelain
interface of the restoration will be situated subgingi-
vally.1 In some clinical instances, there is a need to
place the implant deep subgingivally due to bone
availability.2 Particularly in patients with cleft palate
and patients with severe bone resorption, the
overlying soft tissue may be too thick to be
transversed by standard length healing abutment.
This situation could result in an uncomfortable
Burak Yilmaz, DDS, PhD, is an implant prosthodontic fellow,
Department of Restorative and Prosthetic Dentistry, The Ohio State
University, College of Dentistry, Columbus, Ohio, and postdoctoral
fellow, Department of Prosthodontics, Faculty of Dentistry, Baskent
University, Ankara, Turkey. Address correspondence to Dr Burak
Yilmaz at The Ohio State University, College of Dentistry, Department
of Restorative and Prosthetic Dentistry, Columbus, OH 43218. (e-mail:
brk.yilmaz@yahoo.com)
Edwin McGlumphy, DDS, MS, is associate professor, Department of
Restorative and Prosthetic Dentistry, The Ohio State University,
College of Dentistry, Columbus, Ohio.
Ilser Turkyilmaz, DDS, PhD, is an assistant professor, University of
Texas Health Science Center in San Antonio, Tex.
condition for the patient and a difficult management
issue for the implant surgeon. Moreover, the prosthetic
phase may be extended due to irregular soft tissue
contours preventing impression procedures (Figure 1).
Multiple problems occur when the clinician does not
have enough healing abutment height options.
This article describes a simple technique to increase
the height of the healing abutment with laser welding
when an implant is placed deep with thick overlying soft
tissue. The advantages of this procedure are that a taller
healing abutment can be provided in a short amount of
time; thus, the technique may accelerate the prosthetic
phase and provide comfort and convenience to the
patient for any implant system while allowing proper
soft tissue healing. The technique may be useful for
clinicians who have access to one of the laser welding
machines that are commonly available in many local
laboratories. The requirement to extend the length of
the healing abutment could have been avoided if an
implant system with long enough healing abutments or
modified regular abutments had been chosen for these
types of cases.
TECHNIQUE
1. Check the interocclusal distance between the free
gingival margin and implant platform, and the free
gingival margin and the opposing tooth with a
periodontal probe.
2. Choose 2 appropriate-length healing abutments
(Astra Tech AB; Gothenburg, Sweden) with the
same width, which, when laser welded together, do
not infringe upon the interocclusal distance (Fig-
ures 2 and 3).
Journal of Oral Implantology 201
EXTENSION OF THE LENGTH OF AN IMPLANT HEALING ABUTMENT

FIGURES 17. FIGURE 1. Subgingivally placed implant and irregular soft tissue contours. FIGURE 2. Primary and secondary healing abutments in
same diameter. FIGURE 3. Measurement of required height to be added onto the primary healing abutment. FIGURE 4. Primary healing
abutment with flattened top and the sectioned part from secondary healing abutment. FIGURE 5. Laser welding of the small part onto
primary healing abutment. FIGURE 6. New long healing abutment with polished welded surface. Note height of new healing abutment when
compared to its original size. FIGURE 7. Intraoral view of the new long healing abutment.

202 Vol. XXXV/No. Four/2009


3. Screw the healing abutments on proper analogues
(Astra Tech AB) to ease handling during cutting and
welding procedures.
4. Flatten the top surface of the primary healing
abutment with appropriate burs, if necessary.
5. Cut part of the required height from the top of the
secondary healing abutment with appropriate
disks. This sectioned small part will be placed on
top of the primary abutment during laser welding
(Figure 4).
6. Laser-weld the small part that was split from the
secondary healing abutment onto the primary
healing abutment (Figures 5 and 6).
7. Polish the welded surface with appropriate burs in
order to obtain a smooth soft tissue surface.
Carborundum disks and stones of varying degrees
of coarseness can be used first; these are followed by
garnet paper and sandpaper disks, rubber points, and
white Arkansas stone, and rubber wheels.
Burak Yilmaz et al
8. Screw the new long healing abutment on the
implant and follow prosthetic procedures after
adequate healing (Figure 7).
ACKNOWLEDGMENTS
The authors thank Andrea Company and Andy
Stevenson for their valuable contribution to this
manuscript.
REFERENCES
1. McGlumphy, EA. Implant-supported fixed prostheses. In:
Rosenstiel SF, Land MF, Fujimoto J, eds. Contemporary Fixed
Prosthodontics. 4th ed. St Louis, Mo: Elsevier; 2006:466504.
2. Lee H, Ercoli C, Funkenbusch PD, Feng C. Effect of
subgingival depth of implant placement on the dimensional
accuracy of the implant impression: an in vitro study. J Prosthet
Dent. 2008;99:107113.
Journal of Oral Implantology 203