What exactly is a "custom abutment" for an implant crown...

Discussion in 'Dental Archive' started by JimSocal, Jun 23, 2008.

  1. JimSocal

    JimSocal Guest

    .... and when is it necessary to have one?
    JimSocal, Jun 23, 2008
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  2. JimSocal

    Richard Guest

    A custom abutment is a part that is machined out of a block of titanium
    which fits into the implant and a crown is made over it. Some doctors or
    laboratories use them for all of their cases, some use modified stock
    abutments. I have never used them. For more info:

    JimSocal wrote:
    Richard, Jun 26, 2008
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  3. Richard wrote:

    This looks like an interesting technology, but most custom abutments
    are not milled by a CAD-CAM technology--they are custom cast, usually
    in gold alloy (there is a titanium understructure that screws into the
    implant fixture.
    They are generally used when the placement of the implant fixture is
    such that it is not possible to place a functional, esthetic crown using
    a stock (pre-made) abutment. Of course, occasionally fixtures are
    placed such that it's impossible to put a crown or attachment in a good
    clinical position. That's why collaboration between the surgeon and
    restorative dentist is so important.


    Mark & Steven Bornfeld DDS
    Brooklyn, NY
    Mark & Steven Bornfeld, Jun 26, 2008
  4. JimSocal

    JimSocal Guest

    On Thu, 26 Jun 2008 15:06:52 GMT, Mark & Steven Bornfeld
    <> wrote:
    Thank you Richard and Dr. Bornfeld for your answers.

    This is what my student dentist told me (I got an email back from her
    after your replies; this work was done about a year ago):

    "custom abutments are not required, stock abutments could have been
    used, but in my experience results are better with custom abutments
    especially when multiple implants are used as in your case. Some form
    of abutment has to be used otherwise the PFM (crown) can not be
    placed, since it is the connector between the implant screw and crown.

    I'm not sure why your original treatment plan did not include the
    custom abutments, it might have been that at the time of your original
    treatment plan the University did not charge for abutments."
    By the way, if her last comment is the case, then I think the prices
    on my treatment plan should be honored.

    This is why I am asking the question:
    I had a Treatment Plan for 4 implant crowns and it called for 6
    implant crowns at $850 each. [2 had not yet been done at the time of
    this bill). This is what I agreed to and I was never told anything
    different was going to be done or that any expenses were being added.

    So when I got my bill, I saw that I was charged $675 for the Implant
    crowns, high noble - but also 4 x $650 for "Implant Custom Abutments".

    So that is $2600 more than what I was told I'd be charged, and no one
    dicussed this with me! (??!!)

    (Granted, the PFM's were $175 less each so that offsets some of the
    difference, but still that leaves a $1900 difference added.)

    So I am in the process of contesting this on the grounds that I was
    never told they would be needed.

    Would it not be standard practice to tell a patient if an extra $2600
    was going to be added to his bill? especially if he has a signed
    treatment plan that does not call for custom abutments?

    I think at the very least they should compromise with me and charge me
    LESS for the custom abutments.

    What do you think?

    And maybe you can help me out here - if I paid $650 per crown and $675
    per custom abutment (remember, this is at a dental school, so I should
    get it cheaper - I had to endure many more appt's than necessary for
    their lack of competence and many more hours in the chair for the same
    reason plus they are learning on me), how much room is there for them
    to discount this any further to allow for any money back due to their
    having not told me about it?

    I'm willing to compromise as I understand it may have just been an
    oversight, but still I don't think it's right to expect a person to
    pay $1900 more than their treatment plan called for without having
    told them.

    And finally, what would be an average ballpark price for custom
    abutments per crown at a dental office?

    Comments? Opinions?
    JimSocal, Jul 2, 2008
  5. JimSocal wrote:

    I've done custom abutments where the lab fee is over $600. There
    should be some profit margin, but ordinarily I don't think it needs to
    be much, as it's basically nuts and bolts. But the materials charges
    are high, and the tools required are expensive.
    You are asking a question that really is contract law. I'm guessing
    that you must have signed some kind of consent or contract. If so, the
    fee estimate should be spelled out (with reasonable provisions for
    unanticipated changes). IMO the need for abutments should be explained
    to the patient, but in my experience some patients remember, and some
    don't. I have no idea about the legal issues, so I can't help you there.


    Mark & Steven Bornfeld DDS
    Brooklyn, NY
    Mark & Steven Bornfeld, Jul 2, 2008
  6. JimSocal

    JimSocal Guest

    On Wed, 02 Jul 2008 19:36:14 GMT, Mark & Steven Bornfeld
    <> wrote:

    Thanks for your feedback.

    It's kind of weird, (almost "flaky" in fact!) but I am almost 100%
    certain that even with $12k or surgeries and crowns etc., I never
    signed *anything* other than this treatment plan and the treatment
    plan is not a "contract" per se (i.e.; no long winded legalese) just a
    statement of needing these procedures and the cost with signatures by
    me, the student and the prof. If I did sign something it was in the
    very beginning, that I had to sign to get admitted to the program. But
    never signed anything but this treatment plan after that. In fact I
    have every piece of paper they've given me in a notebook and there is
    nothing else.

    And I am 100% certain that the need for Custom Abutments was never
    explained, in fact I was shocked to see them on the bill and thought
    they were a mistake.

    Now, I find it interesting that the student dentist wrote me back and
    said " I'm not sure why your original treatment plan did not include
    the custom abutments, it might have been that at the time of your
    original treatment plan the University did not charge for abutments."

    I find it interesting because it seems to me that it should have been
    HER (or at least her professor) who should have told me if there was
    any change to my treatment plan, as per custom abutments. But it seems
    they just did what they wanted with no concern for cost to me or my

    Also there is this:
    I just finished my last 2 crowns (a 2 crown bridge) with the same
    school, though a different dept., and they did NOT use custom
    abutments and when I asked the prof there about why these custom
    abutments might have been used, he said "I have no idea why" as if it
    was not standard policy.

    I guess I cannot prove they never told me about the change, but then
    again, they cannot prove they did (because they did not).

    So at the very least we should work out a compromise in which I get
    some of the money taken off my bill, I think. Otherwise I guess I'll
    take it to Small Claims court.
    JimSocal, Jul 2, 2008
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