Generic Root Form

Component Terminology

CHAPTER Carl E. Misch

A
n endosteal implant is an alloplastic material surgi- Surgical cobalt chromium molybdenum alloy was intro-
cally inserted into a residual bony ridge primarily as duced to oral implantology in 1938 by Strock8 when he
a prosthodontic foundation.1 The prefix endo means replaced a maxillary left incisor single tooth, an implant
“within,” and osteal means “bone.”2 The major subcategory of that lasted more than 15 years. In 1946 Strock designed a
endosteal implants covered in this text are root form implants. two-stage screw implant that was inserted without a per-
The term endosseous also is used in the literature. Because the mucosal post. The abutment post and individual crown
term osseous also indicates bone, either term is acceptable. were added after complete healing.9 The desired implant
However, endosteal, periosteal, and transosteal are preferred. interface at this time was described as ankylosis, which may
Root form implants are the design most often used in be equated to the clinical term rigid fixation. The first sub-
restoration of the partial or completely edentulous patient. merged implant placed by Strock was still functioning
The desire has always been to replace missing teeth with 40 years later10 (Fig. 3-2).
something similar to a tooth. Root form implant history Bone fusing to titanium was first reported in 1940 by
dates back thousands of years and includes civilizations Bothe et al.11 Brånemark12 began extensive experimental
such as the ancient Chinese, who 4000 years ago carved studies in 1952 on the microscopic circulation of bone mar-
bamboo sticks the shape of pegs and drove them into the row healing. These studies led to dental implant application
bone for fixed tooth replacement. The Egyptians, 2000 years in early 1960; 10-year implant integration was established in
ago, used precious metals in a similar method, and a skull
was found in Europe with a ferrous metal tooth inserted
into a skull in similar fashion. Incas from Central America
took pieces of sea shells and tapped them into the bone to
replace missing teeth3 (Fig. 3-1). In other words, to replace
a tooth with an implant has always made sense. In reality,
if the lay public was given a choice to replace a missing
tooth with an implant or to grind down several adjacent
teeth and connect them to a bridge to replace a missing
tooth, making it harder to clean, and attempting to make
the adjacent teeth look similar to the condition before their
preparation, the implant would be the obvious choice.
Maggiolo4 introduced the more recent history of implant
dentistry in 1809 using gold in the shape of a tooth root. In
1887 Harris5 reported the use of teeth made of porcelain into
which lead-coated platinum posts were fitted. Many materials
were tested, and in the early 1900s Lambotte6 fabricated
implants of aluminum, silver, brass, red copper, magnesium,
gold, and soft steel plated with gold and nickel. He identi-
fied the corrosion of several of these metals in body tissues
related to electrolytic action. The first root form design that Figure 3-1 Implant dentistry is the second oldest discipline
differed significantly from the shape of a tooth root was the in dentistry (oral surgery [exodontia] is the oldest). Implants date
back more than 4000 years, when the Chinese carved bamboo
Greenfield latticed-cage design in 1909, made of iridoplat-
stakes and hammered them into the bone for fixed tooth replace-
inum.7 The surgery was designed to use a calibrated ment. This mandible, dated AD 600, was found in Honduras. Inca
trephine bur to maintain an inner core of bone within the Indians carved sea shells into stakes and tapped them into the
implant. The implant crown was connected to the implant bone, such as this jaw with three incisors implanted. Calculus for-
body with an internal attachment after several weeks. mation on these three implants indicate this was not a burial cere-
Reports indicate this implant had a modicum of success. mony, but a fixed, functional, and esthetic tooth replacement.

32
 Generic Root Form Component Terminology 33

Many practitioners are taught the use of a specific man-

ufacturer’s implant system rather than the theory and com-
prehensive practice of implant dentistry. The increasing
number of manufacturers entering the field use trade names
for their implant components (often unique to a particular
system), and such names have proliferated to the point of
creating confusion. Several different terms or abbreviations
now exist that describe similar basic components.20-23
To make conditions worse, in the team approach to
implant treatment the widening referral base often requires
that the restoring practitioner be knowledgeable regarding
many implant systems. With the required knowledge of mul-
tiple systems and the lack of uniformity in component names,
Figure 3-2 Al Strock, from Boston, Mass., invented a series communication is hampered among manufacturers, dentists,
of two-stage endosteal implants in 1948. This patient received one staff, laboratory technicians, students, and researchers. In
of these implants to replace a maxillary lateral incisor. The patient addition, the incorporation of implant dentistry into the
presented in 1986 with the implant still in function 38 years later. curriculum of most predoctoral and postdoctoral programs
further emphasizes the need for standardization of terms
and components in implant dentistry.24 This chapter pro-
poses a generic terminology, first introduced by Misch for
endosteal implants, that attempts to blend the continuity and
dogs without significant adverse reactions to hard or soft tis- familiarity of many implant systems with established defini-
sues. Studies in human beings began in 1965, were followed tions from the Illustrated Dictionary of Dentistry and the glos-
for 10 years, and were reported in 1977. Osseointegration, as saries of the Academy of Prosthodontics and the American
first defined by Brånemark, denotes at least some direct con- Academy of Implant Dentistry.1,2,25,26
tact of living bone with the surface of an implant at the light
microscopic level of magnification.13 The percentage of
direct bone-implant contact varies. The term osseointegration GENERIC IMPLANT BODY
has become a common term in the implant discipline, TERMINOLOGY
which describes not only a microscopic condition but also a
clinical condition. A more generic term, osteointegration also Root form implants are a category of endosteal implants that
is used widely by the profession. To determine true osteoin- are designed to use a vertical column of bone, similar to the
tegration by the original definition, the implant must be root of a natural tooth. Although many names have been
removed and evaluated under a microscope. In reality, rigid applied, the 1988 National Institutes of Health consensus
fixation defines the clinical aspect of this microscopic bone statement on dental implants and the American Academy of
contact with an implant and is the absence of mobility with Implant Dentistry recognize the term root form1,19 (Fig. 3-3).
1 to 500 g force applied in a vertical or horizontal direction. The exponential growth of implant use over the last 20
Rigid fixation is the clinical result of a direct bone interface years has been paralleled by an explosion of the implant
but also has been reported with a fibrous tissue interface. manufacturing field. Currently, more than 90 designs are
No other person in recent history has influenced root available, offering countless combinations of implant body
form implant concepts more than Brånemark. The docu- design, platform shapes, diameter, length, prosthetic con-
mentation of past clinical case studies, research of surgery nections, surface conditions, and interfaces.26-47
and bone physiology, healing of soft and hard tissues, and The most common root form design combines a separate
restorative applications from Brånemark’s laboratory were implant body and prosthodontic abutment to permit the
unprecedented. Adell et al.13 published their 15-year clinical implant placement under the soft tissue during initial bone
case series report in 1981 on the use of implants in com- healing. A second surgical procedure is required to uncover
pletely edentulous jaws. About 90% of the reported anterior the implant as a two-stage surgical approach, separated by
mandibular implants that were in the mouths of patients the hard tissue healing process. The design philosophy is to
after the first year were still in function 5 to 12 years later. achieve clinical rigid fixation that corresponds to a micro-
However, lower survival rates were observed in the anterior scopic direct bone-to-implant interface without intervening
maxilla. No implants were inserted into the posterior fibrous tissue occurring over any significant portion of the
regions of the mouth in the original clinical trials. implant body.
The use of dental implants to treat complete and partial More recently, implant body designs with a permucosal
edentulism has become an integral treatment modality in section have been developed to allow a one-stage (unsub-
restorative dentistry.14-17 A 1990 survey indicated more than merged) approach. Also, the immediate load techniques are
90% of oral and maxillofacial surgeons, periodontists, and reported more widely on two-piece and one-piece implant
prosthodontists and more than 50% of general dentists had designs.
attended a professional development course on implants The macroscopic body design can be a cylinder, thread,
during the preceding 3 years.18 The 1988 National Institutes plateau, perforated, solid, hollow, or vented; the surface can
of Health consensus panel on dental implants recognized be smooth, machined, coated, or textured. The designs are
that restorative procedures using implants differ from those available in submergible and nonsubmergible forms in a
of traditional dentistry and stressed the necessity for variety of biocompatible materials. Three primary types of root
advanced education.19 form endosteal implants are available based on design.26
34 DENTAL IMPL ANT PR OSTHETICS

Figure 3-3 Hundreds of different implant body designs are available in the world today.
These generally relate to three different categories: cylinder implants (top row), screw design
implants (middle row), or a combination (bottom row), which usually are pressed into position and
have a macro body design similar to a thread form. (Courtesy Charles English, Little Rock, AR.)

Cylinder (press fit) root form implants depend on a coating

or surface condition to provide microscopic retention and
bonding to the bone and usually are pushed or tapped into
a prepared bone site. They can be straight, tapered, or con-
ical. Screw root forms are threaded into a bone site and have
macroscopic retentive elements for initial bone fixation.
These root forms may be machined, textured, or coated.
Three basic screw-thread geometries are V-thread, buttress
thread, and power (square) thread designs that are com-
bined with different geometric shapes. Threaded implants
are now available in straight, tapered, conical tapered, Crest module
ovoid, and expanding designs. Combination root forms have
macroscopic features of the cylinder and screw root forms.
Micro or macro thread features, alternating thread pitch,
depth, and self-tapping features can be combined to create
a myriad of implant designs from which to choose. The Body
screw or combination root form designs also may benefit
from microscopic retention to bone through varied surface
treatment (machined, textured, etched, resorbable blast
medium [RBM]) and the addition of coatings or macroscopic
features such as baskets, vents, grooves, ledges, plateaux,
and fins.48-61 Root forms also have been described by their
means of insertion, healing, surgical requirements, surface Apex
characteristics, and interface.20-23

IMPLANT BODY REGIONS Figure 3-4 An implant body is the portion of the dental
implant that is designed to be placed into the bone to anchor
The implant body may be divided into a crest module prosthetic components. The implant body has a crest module,
(cervical geometry), a body, and an apex (Fig. 3-4). body, and apex.
 Generic Root Form Component Terminology 35

the surface area of bone contact would be more than

Implant Body
30% higher compared with the smooth cylinder design.
A solid screw implant body design with a blunt apex offers The greater the functional surface area of the bone implant
significant advantages to the practitioner with limited contact, the better the support system for the prosthesis. In
experience or limited availability of different implant addition, if bone loss occurs around a coated implant, a
systems. A solid screw is defined as an implant of a circular biological smear layer attaches to the coating. The contami-
cross section without any vents or holes penetrating the nated coating often must be removed for the bone to
implant body. A number of manufacturers provide this readapt to the implant. However, once the coating is
design. The V-shaped threaded screw has a long history of removed, the cylindrical implant primarily imposes shear
clinical use12,13; the most common thread outer diameter is loading to the bone implant interface. Bone is 65% weaker
3.75 mm, with a 0.4 mm depth of thread and a crest mod- in shear force compared with compression. As a result,
ule about 2 mm in height and crestal diameter of 4.1 mm. future bone loss is even more likely. Once the surface is
The various lengths range from 7 to 20 mm; lengths from decontaminated and bone is regenerated next to the implant,
10 to 16 mm are the most widely used. This design now is the threaded implant still can transmit compression and
offered in a variety of diameters (narrow, standard, wide) to tensile forces to bone. Hence surgical correction of bone
better answer the mechanical, esthetic, and anatomical loss has better prognosis with screw-type implants.
requirements in different areas of the mouth.62,63
A solid screw permits the preparation and placement of
the implant in dense cortical bone and in fine trabecular
Crest Module
bone. The surgery may be modified easily to accommodate The crest module of an implant is that portion designed to
both extremes of bone density. The solid screw permits the retain the prosthetic component in a two-piece system; it
implant to be removed at the time of surgery if placement also represents the transition zone from the implant body
is not ideal. A solid implant may perforate the inferior design to the transosteal region of the implant at the crest
border of the mandible, nares, or maxillary sinus without of the ridge. The crest module also may be designed to exit
inherent complication if the apex is smooth or blunted. the soft tissue in some implant systems (e.g., the ITI
The solid screw may be plasma spray-coated with titanium implant system). The abutment connection area often has a
or hydroxyapatite to marginally increase the functional platform on which the abutment is set; the platform offers
surface area, microlock the bone, and take advantage of physical resistance to axial occlusal loads. An antirotation
biochemical properties related to the surface coating feature often is included on the platform (external hexa-
(e.g., bone bonding or bone growth factors). gon) but may extend within the implant body (internal
Manufacturers also may provide slightly smaller or larger hexagon, Morse taper, internal grooves). The implant body
implant diameters for use in limited anatomical situations has a macroscopic design (e.g., threads or large spheres),
or surgical complications. A solid screw also permits the whereas the crest module is often smoother to impair
implant to be removed at the Stage II surgery if angulation plaque retention if crestal bone loss occurs. The apical
or crestal bony contours are not adequate for long-term dimension of the crest module varies greatly from one
prosthesis success. system to another (0.5 mm to 5 mm).
The functional surface area of a threaded implant is The platform features a coupling that is above or below
greater than a cylinder implant by a minimum of 30% and the crestal bone level. Nonrotational features are typically
may exceed 500%, depending on the thread geometry. This part of this element. The classic connection above the plat-
increase in functional implant surface area decreases the form is an external hexagon of dimensions varying with
stress imposed on the implant bone interface and also manufacturers and implant diameter.
depends on thread geometry. A high-precision fit of the external hexagon, flat-to-flat
A cylinder implant design system offers the advantage of dimension is paramount to the stability of the implant
ease of placement, even in difficult access locations. For body–abutment connection.62-66 Internal connections can
example, in the very soft D4 bone of the posterior regions be of the internal hexagon or octagon type. Other geomet-
of the maxilla, a 70 : 1 handpiece, rather than a hand rics include octagonal, cone screw, cylinder hexagon,
wrench, is needed to insert a threaded implant design. Very spline, cam tube, and pin slots. The connection is received
soft bone otherwise may be displaced during the hand by slip-fit or friction-fit with butt or bevel joint. All aim at
ratchet procedure, and the implant will not be rigid. providing a precise mating of the two components with
A cylinder implant may be pressed into the bone by hand minimal tolerance. A multitude of patents have been filed
in hard or soft bone. The cylinder system also has some touting the merits of a particular design, and one can
benefits for the single-tooth implant application, especially expect the field will see more creative versions as the field
if the crown height of the adjacent teeth is large. Extenders further expands.
are needed for the screw implant placement in these situa-
tions, as well as additional armamentarium to insert the
cover screw of the implant. Cylinder systems also are easier
Implant Collar
and faster to place because bone tapping is not required. A cervical collar may be incorporated: its design varies from
The speed of implant rotation during insertion and the straight to flared neck, beveled, reverse bevel, tapered,
amount of apical force in implant insertion are also less smooth, surfaced, or microthreaded. Designs that incorpo-
relevant. rate a microscopic component into the implant bodies by
However, most cylinder implants are essentially smooth- coatings with hydroxyapatite or titanium often have an
sided and bullet-shaped implants that require a bioactive or implant collar at the superior aspect of the crest module.
increased surface area coating for retention in the bone. Prevention of hydroxyapatite exposure above the bone may
If these same materials were placed on a threaded design, be one solution to decrease the potential bacterial liability.
36 DENTAL IMPL ANT PR OSTHETICS

From observations of a number of hydroxyapatite-coated Prosthesis screw

cylinder Integral implants exhibiting morbidity, Block and
Kent67 made recommendations to reduce complications,
Coping
including (1) caution in placing implants in thin bone or
extraction sites without adequate bony coverage or grafting
Analog
and (2) primary closure to prevent premature exposure and
A. Implant body
possible bone loss. However, the amount of bone remodel- B. Abutment A B
ing following implant placement is difficult to predict. The
inclusion of a metal collar allows functional remodeling to
Transfer coping
occur to a more consistent region on the implant.68 Studies (abutment or implant body)
on osseous healing around implants69,70 suggest that crestal A. Indirect
remodeling is limited to the smooth region of the collar. B. Direct A B
As a result of this remodeling, the sulcular epithelium
migrates to the base of the implant collar. However, no sig-
nificant differences in the probing depths between healthy Hygiene screw
implants with and without coronal collars have been
noted69 probably because of the close adaptation of circular Abutment
fibers encircling the implant neck.71 A. For screw retention
Besides the possible prevention of hydroxyapatite expo- B. For cement retention
sure, an additional advantage of using a machined coronal C. For attachment A B C
portion is the potential for an improved interface at the
abutment connection. Although the machined collar
Second-stage permucosal
region may provide this advantage, the collar contributes extension or healing
little to the biomechanical support at the bony crest where abutment
stresses are most severe; one must consider this factor in
treatment planning and prosthesis design. Therefore the First-stage cover screw
machined collar limited in height to 0.5 to 1 mm provides
the biological and abutment connection advantages and
limits the biomechanical disadvantage.
Implant body

GENERIC PROSTHETIC COMPONENT

TERMINOLOGY
Figure 3-5 Implant components most often have terms that
Misch and Misch26 developed a generic language for are different for each company. Misch and Misch26 published a
endosteal implants in 1992. This language is presented in an generic language that applies to any product. This language per-
order following the chronology of insertion to restoration mits improved communication between referring doctors and
(Fig. 3-5). In formulating the terminology, five commonly laboratories, which often must be familiar with several different
used implant systems in the United States were referenced. systems. (From Misch CE: Contemporary implant dentistry, ed 2,
Ten years later, the dramatic evolution of the U.S. St Louis, 1999, Mosby.)
implant market has resulted in the complete disappearance
of some and the multiplication and mutation of others
through mergers and name changes. To make matters
worse, even if the company remained the same, changes in
the implant line and component design (dimensions or
connection types) may have taken place. A 1998 article After a prescribed healing period sufficient to allow a
reported that in the U.S. alone the profession now has to supporting interface to develop, a second-stage procedure
choose from more than 1300 implants and 1500 abutments may be performed to expose the implant or to attach a
in various materials, shapes, sizes, diameters, lengths, transepithelial portion.25 This transepithelial portion is
surfaces, and connections.62 More than ever, a common termed a permucosal extension because it extends the implant
language is needed. Just as in pharmacology in which the above the soft tissue and results in the development of
multiplicity of pharmaceutical components makes it a permucosal seal around the implant. This implant compo-
impossible to list them all by proprietary names but by cat- nent also is called a healing abutment because Stage II uncov-
egory, implant components still can be classified into broad ery surgery often uses this device for initial soft tissue
applications/indications categories, and the practitioner healing (Figs. 3-6 and 3-7).
should be able to recognize a certain component category In the case of a one-stage procedure, the surgeon may
and know its indications and limitations. have placed the permucosal extension at the time of
At the time of insertion of the implant body or Stage I implant insertion or may have selected an implant body
surgery, a first-stage cover is placed into the top of the design with a cervical collar of sufficient height to be
implant to prevent bone, soft tissue, or debris from invad- supragingival. In the case of immediate load, the permu-
ing the abutment connection area during healing. If the cosal healing abutment may not be used at all if a tempo-
first-stage cover is screwed into place, the term cover screw rary prosthesis is delivered on the day of surgery or may
may be used. be used until the suture removal appointment and the
 Generic Root Form Component Terminology 37

temporary teeth delivery. The healing abutment is available

in multiple heights to accommodate soft tissue variations
and also can be straight or flared or anatomical to assist in
the soft tissue healing sculpture.
The abutment is the portion of the implant that supports
or retains a prosthesis or implant superstructure.25 A super-
structure is defined as a metal framework that fits the
implant abutment(s) and provides retention for a removable
prosthesis1 (e.g., a cast bar retaining an overdenture with
attachments) or provides the framework for a fixed prosthesis.
Three main categories of implant abutment are described,
according to the method by which the prosthesis or super-
structure is retained to the abutment: (1) an abutment for
screw retention uses a screw to retain the prosthesis or super-
structure; (2) an abutment for cement retention uses dental
cement to retain the prosthesis or superstructure; and (3) an
Figure 3-6 The permucosal extension (PME) attaches to the abutment for attachment uses an attachment device to retain a
implant body and allows the soft tissue to heal and mature around removable prosthesis (such as O-ring attachment) (Figs. 3-8
the future implant abutment. The PME may be the same size as the to 3-10). Many manufacturers classify the prosthesis as fixed
crest module of the implant body (left) or slightly larger (right) and
helps develop the emergence contour of the implant crown.

Abutment for Angled Profile

cement abutment abutment

One-piece
abutment
Figure 3-7 An intraoral view of eight second-stage permu-
cosal extensions that were inserted into the implant bodies. Figure 3-9 Abutment for cement retention may be one
piece (far left) or two pieces, which are retained by a separate
abutment screw.

Abutment for screw O-ring abutment

Figure 3-8 An abutment for screw retention is used for a Figure 3-10 Abutment for attachment is used for removable
screw-retained bar or fixed prosthesis. (Courtesy BioHorizons, prostheses that are implant retained. These may be used for com-
Birmingham, Ala.) plete dentures and/or partial dentures.
38 DENTAL IMPL ANT PR OSTHETICS

whenever cement retains the prostheses, fixed/removable

when screws retain a fixed prosthesis, and removable when
the restoration can be removed by the patient. This descrip-
tion implies that only screw-retained prostheses may be
removed. The description is not accurate because the den-
tist also may remove a fixed-cemented prosthesis. Hence the
generic language in this chapter separates prostheses into
fixed or removable as does traditional prosthetics. The abut-
ment may be screwed or cemented into the implant body,
but this aspect is not delineated within the generic termi-
nology. Each of the three abutment types may be classified
further as straight or angled abutments, describing the axial
relationship between the implant body and the abutment.
An abutment for screw retention uses a hygiene cover screw
placed over the abutment to prevent debris and calculus
from invading the internally threaded portion of the abut-
ment during prosthesis fabrication between prosthetic Figure 3-12 A customized abutment with tooth-colored
appointments. ceramic and ideal emergence profile from the implant body. If the
The paucity of abutment design of a decade ago has been tissue shrinks in the future, the crown will appear longer, but the
titanium color of the abutment will not be evident.
replaced by a plethora of options. The expansion of implant
dentistry, its applications for esthetic dentistry, and the
creativity of manufacturers in this competitive market are
responsible for the explosion of implant abutment styles
available today. In the abutment for cement category, the
doctor may choose from one- and two-piece abutments, Therefore a transfer coping is used to position an analog in
University of California—Los Angeles (UCLA) type (plastic an impression and is defined by the portion of the implant
castable, machined/plastic cast to cylinder, gold sleeve it transfers to the master cast, either the implant body trans-
castable), two-piece esthetic, two-piece anatomical, two- fer coping or the abutment transfer coping.
piece shoulder, preangled (several angulations), or tele- Two basic implant restorative techniques are used to
scopic mullable ceramic (Figs. 3-9, 3-11, and 3-12). The make a master impression, and each uses a different design
abutment for screw category also has been enlarged with transfer coping, based on the transfer technique performed.
one- and two-piece overdenture abutments of different An indirect transfer coping uses an impression material
contours and heights. requiring elastic properties.25 The indirect transfer coping is
An impression is necessary to transfer the position and screwed into the abutment or implant body and remains in
design of the implant or abutment to a master cast for place when the set impression is removed from the mouth.
prosthesis fabrication. A transfer coping is used in traditional The indirect transfer coping is parallel-sided or slightly
prosthetics to position a die in an impression25 (Fig. 3-13). tapered to allow ease in removal of the impression and
Most implant manufacturers use the terms transfer and coping often has flat sides or smooth undercuts to facilitate reori-
to describe the component used for the final impression. entation in the impression after removal. A direct transfer
coping usually consists of a hollow transfer component,
often square, and a long central screw to secure it to the abut-
ment or implant body and may be used as a pickup impres-
sion coping. After the impression material is set, the direct
transfer coping screw is unthreaded to allow removal of the
impression from the mouth. Direct transfer copings take
advantage of impression materials having rigid properties
and eliminate the error of permanent deformation because
they remain within the impression until the master model
is poured and separated (Fig. 3-14).
An analog is something that is analogous or similar to
something else.25 An implant analog is used in the fabrication
of the master cast to replicate the retentive portion of the
implant body or abutment (implant body analog, implant
abutment analog). After the master impression is obtained, the
corresponding analog (e.g., implant body or abutment for
screw) is attached to the transfer coping and the assembly is
poured in stone to fabricate the master cast (Figs. 3-15, 3-16,
Figure 3-11 On a custom abutment, porcelain may be built and 3-17).
between the crown margin and the abutment-to-implant position. A prosthetic coping is a thin covering,25 usually designed
This buildup allows the crown margin to be above the bone, yet to fit the implant abutment for screw retention and serve as
the subgingival region has pink or tooth-colored porcelain and a the connection between the abutment and the prosthesis
customized shape to improve esthetics. or superstructure. A prefabricated coping usually is a metal
 Generic Root Form Component Terminology 39

Type of restoration

Single-tooth restoration Multiple-unit restoration

Ball-top Direct- Ball-top Indirect One-piece Direct-

screw transfer screw impression abutment transfer
coping coping— for cement— coping
screw nonhexed nonhexed screw

Straight
abutment Direct- Direct-
for cement— transfer— Straight abutment transfer—
hexed hexed for cement—hexed nonhexed

Closed-tray technique Open-tray technique Closed-tray technique Open-tray technique

Color-code scheme
Blue
5.0 mm
Green
4.0 mm
Yellow
3.5 mm O-Ring O-Ring abutment
abutment analog
Indirect analog

Figure 3-13 An indirect transfer (far left and center ) is inserted into an implant body or
abutment for screw retention and a closed tray impression is made. The impression is removed
and the transfers are connected to an analog and reinserted into the impression. A direct impres-
sion transfer (far right ) uses an open tray to make the impression. The direct transfer coping
screw must be unthreaded before the impression is removed from the mouth. (Courtesy
BioHorizons, Birmingham, Ala.)

Figure 3-14 These eight maxillary implants are connected

to two-piece indirect impression transfers, which engage the hexa- Implant analog O-ring abutment analog
gon of the implant platform. A closed-tray impression is made, and
the indirect transfer copings are unthreaded from the implant bod- Figure 3-15 Analogs may represent an abutment for
ies, connected to implant body analogs, and reinserted into the screw retention, an implant body (left ), and/or an abutment for
impression before pouring of the cast. attachment (right ).
40 DENTAL IMPL ANT PR OSTHETICS

regardless of the implant system used; the term is descrip-

tive of the function of the component rather than its pro-
prietary name.

References
1. AAID Nomenclature Committee: Glossary of implant
terms, J Oral Implantol 16:57-63, 1990.
2. Soblonsky S, editor: Illustrated dictionary of dentistry,
Philadelphia, 1982, WB Saunders.
3. Anjard R: Mayan dental wonders, Oral Implantol 9:423, 1981.
4. Maggiolo: Manuel de l’art dentaire [Manual of dental art],
Nancy, France, 1809, C Le Seure.
5. Harris SM: An artificial tooth crown on a root, Dent Cosmos
55:433, 1887.
6. Lambotte A: New instrumentation for the banking of
bones: “banding with a screw,” J Chir Ann Soc Belge Chir
Figure 3-16 An indirect closed-tray impression in a 9:113, 1909.
“customized” impression tray, which also is related to the incisal 7. Greenfield EJ: Implantation of artificial crowns and bridge
edge of the patient to the laboratory technician. The indirect abutments, Dent Cosmos 55:364-430, 1913.
impression transfers have been attached to implant body analogs 8. Strock AE: Experimental work on direct implantation in
and reinserted into the closed-tray impression. the alveolus, Am J Orthod Oral Surg 25:467-472, 1939.
9. Strock AE, Strock MS: Further studies on inert metal
implantation for replacement, The Alpha Omegan 43:107-
110, 1949.
10. Shulman L: Personal communication, 1990.
11. Bothe RT, Beaton LE, Davenport HA: Reaction of bone to
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