A brief introduction to healing caps
The healing cap (also called dental healing abutment or cuff), is a temporary abutment meant to be placed over the dental implant site during the first post-surgical healing stage. Due to its intimate proximity to the surgical site and healing tissue during this phase, the healing abutment plays a vital role in the healing process, particularly of the soft tissue around the implant. As it is responsible for initiating a first phase of soft tissue contouring, proper choice of healing cap dimensions and material will lead to optimal soft tissue healing and positive long-term results for the implant system.
Why use healing caps?
The use of healing caps during the healing of a dental implant is not obligatory, but there is most often a strong case for the use of them. Following the loss of a tooth, the alveolar ridge around the tooth’s socket undergoes alteration and remodeling as the socket heals. The degree to which these alteration and remodeling processes occurs is variable, and based on factors such as individual biology (e.g. gender, age, and hormonal balance), anatomic structure of the jaw, and mechanical properties (e.g. stimulatitive force to the alveolar bone). The first three months of socket healing are the most critical in terms of quantity of bone loss, with alveolar ridge remodeling able to be observed for up to one year after tooth loss (though at a slower rate after the first three months). That said, the dental implant cap is one of two options to the healing process directly after implant placement, with the other being to stitch the gingival tissue above the implant closed during the first healing phase and then reopen the gum for the final prosthesis placement. Healing caps do advantageously remove the necessity for a second surgery.
The healing cap’s contribution to the dental implant system
Dental implants serve as a treatment strategy for patients that have lost one or multiple teeth and have been shown to significantly slow down the atrophy of the jaw bone as a result of tooth loss. Healing caps play an important role in the proper healing of soft tissue and minimizing peri-implant crestal bone resorption around the implant site. Once the implant is placed, the healing cap is inserted on top of the implant platform, filling the marginal void between the implant and its surrounding soft tissue.
Traditional healing caps vs. healing caps that also serve as the final abutment
The healing process takes an average of four to six weeks, after which the implant healing abutment is removed and replaced with the permanent abutment that will connect the implant to the final prosthesis. There are certain healing caps that are designed to serve both as the healing cap and the final abutment, which reduces the amount of material and time needed for the entire procedure. Some dental professionals do advocate the sterilization and reuse of healing caps, but their reuse is generally looked down upon by the professional dental community and thus, healing caps that also serve as the final abutment provide a resolution to this debate.
When healing caps are not recommended for use
Healing caps are most often recommended, however in situations of extreme stability or instability of the patient’s implant, they may be deemed unnecessary or advised against by the treating dentist or implantologist. In the case of highly stable implants, a patient may be eligible for immediate placement of the prosthesis/prostheses. Patients whose implants are loose and unstable, however, may be at risk of improper healing if healing caps are placed. With loose implants, food can get lodged around the implant causing pressure or promoting bacterial infection. Dentists may choose to instead take the alternative route and stitch the gums closed for the duration of the healing process to ensure a safe and successful healing.
The importance of a high quality base material
Base material options for healing caps
The choice of materials used throughout the entire dental implant process have a significant impact on the final success of the implant system. From the implant itself, to the prosthesis, the materials must be selected based on biocompatibility, durability and esthetic quality. As mentioned before, healing caps play a major role in the healing of soft tissues and bone around the implant site, and therefore selection of the best and highest quality material is of critical importance to the success and longevity of the implant. There are two materials primarily used for healing caps: titanium and PEEK.
Titanium healing caps
Titanium first gained its popularity as a reliable workhorse material in the aerospace industry during the 1950’s due to its high strength-to-weight ratio, light weight, and high resistance to corrosion. Today it has become one of the most commonly used materials in the dental industry due to these previously mentioned qualities. Titanium has additional properties that make it ideal for long-term placement in both biological and oral environments, including excellent mechanical properties and high biocompatibility.
PEEK healing caps
Modern dentistry has invested a great deal of research into the esthetic management of implants, as it is considered as much a critical element as is the implant itself. Enter PEEK (polyetheretherkeytone), an organic synthetic polymeric material. The tooth-colored appearance of PEEK has driven it to be widely used today in many implant situations where esthetics are of concern. PEEK surfaces have been found, in comparison to titanium, to accumulate less biofilm and have lower risk of marginal bone loss and soft tissue recession during the implant’s initial healing period.
Being a newer material to the dental implant market, there is still research needed to improve PEEK’s potential. Scientists are working towards a modified PEEK surface that will enhance cell adhesion, proliferation, and biocompatibility that will match that of titanium. When properly seated, titanium abutments have been found to be more capable than PEEK of providing an impervious crestal seal. In this light, however, researchers are optimistic that the surface modifications they are currently working on will enable PEEK to replace titanium in the future.
A promising future for dental implant healing caps
Dental healing caps have drastically improved healing potential in edentulous patients as they go through the initial healing phase after an implant is placed. With a range of diameters, heights, angulations and materials, the options are vast for fitting the healing cap to any individual patient’s unique jaw and tooth morphology. Researchers continue to improve the quality of implant healing abutments to improve function and esthetic, as well as integrating healing caps into the digital dentistry field of CAD/CAM.
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