The Myth of the Angled Abutment

Implant position is critical to esthetic success, especially when the patient has a high smile line and is esthetically aware. At times, using an angled abutment that changes the long axis of the restoration can be helpful, at other times it's at best a poor option, or simply not one at all.

The images below are of an impression made at the time of uncovering an implant in order for me to make a provisional. The surgeon thought an angled abutment might work.

In this case it simply can't, the facial aspect of the implant platform is slightly labial to the cervical margins of the adjacent tooth preparations. Even with a custom abutment in order to angle it palatally enough we most likely will be into the screw head. Even though there is very thick tissue it will migrate apically and the esthetics will be severely compromised. This patient now has three options:

• Remove the implant and graft the area and do another implant.
• Bury the implant and do a bridge with an ovate pontic.
• Trough around the implant and reposition it and hold in place with a tall healing abutment and relining the provisional on top of the healing abutment.