Implant Crown in Ukraine

An implant is a titanium root screwed into the bone. It cannot be used for chewing until the visible part of the tooth is in place above it, and that part consists of two components: the abutment, a connector that protrudes from the gum, and the crown, which reproduces the shape and colour of a natural tooth. Together they form a restoration that is charged separately from the implant surgery.

The prosthetic stage begins once the implant has fused with the bone: usually after 3–4 months in the lower jaw and 4–6 months in the upper, and later after bone grafting. Before starting, the dentist checks the stability of the implant and takes a periapical X-ray: if bone loss is visible around the implant or it moves, work on it does not begin.

Most often it replaces a single missing tooth when the neighbouring teeth are healthy and you would rather not have them filed down for a bridge. If several teeth in a row are missing, the restoration will be different: a bridge on two implants or a screw-retained full-arch prosthesis on four to six supports that only the dentist can remove. These are separate treatments with their own indications and timelines, and we do not cover them here.

The stage is postponed if the mucosa around the implant is inflamed, there is untreated caries or periodontitis in the mouth, or hygiene is poor. Another obstacle is too little vertical space: when less than 5–6 mm remains to the opposing tooth, the restoration has to be designed differently or the bite height restored first. Uncontrolled bruxism without a protective splint is also a reason to deal with the cause first rather than put the work at risk of chipping.

MediUkraine helps patients find and arrange treatment; it is not a clinic. We select the clinic and a dentist with the right specialisation, agree visit dates and support patients throughout, including those travelling from abroad. The dentist decides on the restoration, material and timeline after an examination.

The healing abutment is the first component of the prosthetic stage: a short titanium cylinder that is screwed into the implant in place of the cover screw and left for 2–3 weeks. During this time the mucosa heals around it in a funnel shape, creating the emergence profile, that is, the transition from the round cross-section of the implant to the shape of the neck of a natural tooth. Skipping this step shows straight away: the crown emerges from the gum as a straight column, a dark triangle remains between it and the neighbouring tooth, and food packs into the niche below the contact point.

In the smile zone the profile is more often shaped with a temporary crown than with a healing abutment. It is made from composite or acrylic, material is added to or removed from its cervical part several times, and the gum is given time to adapt to the new shape; this takes anywhere from a few weeks to two or three months. Once both the dentist and the patient are happy with the contour, it is transferred into the permanent work: the technician receives not only an impression of the teeth but also the shape that the soft tissue has taken on.

The shape is passed to the laboratory in one of two ways. The classic one is an impression with a transfer: a metal transfer coping is screwed into the implant and a silicone impression is taken; a closed-tray transfer stays in the mouth and is repositioned in the impression afterwards, while an open-tray transfer comes out with the impression through a hole in the tray and is more accurate. In the front of the mouth the transfer is first customised with composite to match the shape of the temporary crown, otherwise the profile shaped over months will not be captured in the impression. The alternative is an intraoral scan: a scan body is screwed in instead of a transfer, and the file goes to the laboratory without any silicone. This method is quicker and more comfortable, but with a deeply placed implant or a large edentulous area the dentist is more likely to take a conventional impression.

A stock abutment is a factory-made part available in several sizes by height, diameter and angle. It is cheaper, available immediately and, on back teeth with thick gum, usually does its job. Its limitation is that its cross-section is round and symmetrical, whereas the neck of a tooth never is: in the front of the mouth the difference in contour is visible to the naked eye, and the cement margin ends up either too deep or too shallow.

A custom abutment is milled for the specific case from a scan or an impression. The technician reproduces the contour created by the healing abutment or the temporary crown and places the margin where it is needed: slightly below the gum on the visible lip side and almost at gum level on the palatal side, so that excess cement is easier to remove. Abutments are made of titanium, zirconia or a combination of the two. Titanium remains the standard for back teeth, zirconia is chosen in the smile zone, where grey metal may show through thin mucosa, and the most common compromise is a restoration on a titanium base (Ti-base), in which the metal part forms the connection with the implant and carries the load, while the zirconia superstructure takes care of the appearance.

Screw retention means that the crown and abutment are screwed to the implant together, and the screw access channel is closed with PTFE tape and composite. The main advantage is reversibility: the restoration can be removed in a few minutes to tighten the screw, sent to the laboratory to repair a chip, or taken off so that inflamed gums can be treated, and then put back. There is no cement at all, and therefore no risk of it being left under the gum. The trade-off is a hole in the chewing surface, whose filling darkens over the years, and dependence on the angle of the implant: if the channel emerges at the incisal edge of a front tooth, this option is not suitable.

Cement retention gives a continuous surface with no hole: the crown is seated on the abutment with dental cement. This is simpler when the implant is at an awkward angle and gives a better aesthetic result in the front of the mouth. The main risk is residual cement. If the cement margin lies more than 1–1.5 mm below the gum, the excess cannot be fully removed even under magnification, and the cement left behind holds plaque and sustains inflammation around the implant; this shows up not immediately but months later. That is why the margin is raised with a custom abutment and excess cement is cleared with a probe and floss straight after fitting. Note too that a cemented crown cannot be removed without destroying it.

An intermediate option is screw retention with an angled channel, or cementing the crown onto the abutment outside the mouth and then screwing the finished unit in. In the first case a special screwdriver allows the screw access channel to be angled by up to 25–30 degrees and hidden on the palatal side. In the second, the technician cements the crown onto the Ti-base in the laboratory and removes the excess on the bench, so what goes into the mouth is a finished restoration held by a screw. Both solutions combine the reversibility of screw retention with the look of a continuous surface, which is why they are increasingly used in the front of the mouth.

The crown itself is most often made of monolithic zirconia, zirconia with layered porcelain, or porcelain fused to metal. Monolithic zirconia is strong and has no veneering layer that could chip off, so it is chosen for back teeth and for patients with bruxism; it looks plainer, although newer generations of the material are more translucent than the first. Zirconia with layered porcelain looks more natural, but the layered porcelain is what chips most often. Porcelain fused to metal is cheaper and has a decades-long track record; its weak point is a grey line at the gum, noticeable if the gum recedes. Lithium disilicate is used on implants to a limited extent, mainly in the front of the mouth and on a titanium base.

The last stage of the work is checking the occlusion, and on an implant it differs from ordinary prosthetic work. A natural tooth is suspended in the bone by the periodontal ligament and sinks by 25–100 µm under load, while an implant is fused with the bone and moves by only 3–5 µm. If the contacts are made identical, then under heavy clenching the neighbouring teeth give way and the implant takes all the pressure. So the contact is made lighter: with gentle closing, paper 8–12 µm thick passes through almost freely, with firm closing it leaves a faint mark, and the crown does not guide side-to-side jaw movements. This is checked both on the day of fitting and at the follow-up check, because the bite is still changing during the first weeks of adaptation.

Immediately after fitting the gum around the crown turns pale: this is an expected reaction to the pressure of the new shape, and the colour returns within 10–20 minutes. If the crown was cemented, it is best not to eat for the first two hours and not to floss in that area that day, so as not to disturb cement that has not yet reached its final strength.

For a few days the tooth feels unfamiliar: the tongue keeps checking the new surface, the gum is slightly sensitive, and chewing on that side feels unusual. This usually passes within 2–3 days. But if the crown noticeably gets in the way when you close your teeth, presses or hurts when you bite down, see the dentist within a few days rather than putting up with it: most often the cause is a high contact, and the adjustment takes ten minutes.

The gum takes longer to settle than you might expect. The contour stabilises over 4–8 weeks, and the interdental papilla in the front of the mouth may keep filling in for up to a year. That is why the appearance of a crown in the smile zone is usually judged no earlier than 2–3 months later, by comparing photos taken under the same lighting.

One thing to bear in mind: an implant has neither a nerve nor a periodontal ligament, so it does not hurt from overloading or at the onset of inflammation. The first signs of a problem are different: bleeding on brushing, swelling of the gum margin, an unpleasant smell, a feeling that the crown is moving. Pain appears late, when bone loss is already visible on an X-ray.

That is why check-ups follow a schedule, not how you feel. The first check is scheduled 2–4 weeks after fitting: the dentist checks the bite, the gum and how well you clean under the crown. After that come professional hygiene every six months and a periapical X-ray once a year, to track the bone level around the implant over time.

As for lifespan, the honest answer is: an implant is designed to last decades, while the visible part of the restoration is subject to wear. In long-term observation most crowns on implants last more than ten years, after which they are often remade because of chipping, wear or changes in the appearance of the neighbouring teeth. Only a dentist can forecast the lifespan for a particular patient after an examination: it depends on hygiene, the bite, bruxism and smoking more than on the brand of material.