Factores a tener en cuenta a la hora de la selección del pilar protéticopilares metálicos versus pilares cerámicos

Abstract

The diversity of contemporary materials and methods available for the fabrication of implant-supported restorations make the selection of the most adequate treatment modality difficult. New products are continually being developed that are incorporated to the wide range of existing alternatives. Metallic abutments used to be considered a necessary condition for the longevity of the implanted prosthesis. however, the ceramic abutments offer us undeniable clinical advantages. The purpose of this work is to establish a protocol for selecting the ideal abutment, taking into account its biocompatibility with respect to the hard and soft tissues, the mechanical performance and the aesthetic criteria. The most outstanding findings in this review were the following: As regard biocompatibility, there is no evidence that the titanium abutments have greater capacity of maintaining stability of the peri-implant tissue when compared to aluminium or zirconium. In relation to aesthetics, it was verified that in thicknesses of 2 mm or less, the metallic abutments may lead to an apparent change of colour of the peri-implant mucosa. From the mechanical point of view, the survival rates at five years, as well as the incidence of complications seem to be similar in metallic and ceramic abutments; however, the basal reinforcement of the zirconium with titanium contributes to increasing resistance. The incorporation of concepts such as “platform switching” and “one abutment, one time” offer advantages at the aesthetic as well as mechanical level. The selection of the ideal abutment and of the material is influenced by a series of clinical factors as well as by the optical and mechanical characteristics of the material. Among them would be: The scalloped design and the thickness of the soft tissue, smile line, the colour and the shape of the neighbouring teeth, the arch region, occlusal factors, aesthetic expectations and economic criteria.