Redefining the Restorative Interface in Implant Dentistry: Intermediate Multi-Unit Abutments for Enhanced Peri-Implant Tissue Stability.
In tooth replacement therapy with implant-supported prostheses, optimal outcomes depend on a wide range of variables, including anatomic, phenotypic, surgical, and prosthetic factors. Adequate management of the restorative interface is particularly important for achieving predictable esthetic outcomes in the anterior maxilla and for maintaining long-term soft and hard tissue health and stability. This article describes an approach based on the use of intermediate multi-unit abutments on bone-level implants. A comprehensive workflow is presented, integrating digital planning, surgical protocols, and prosthetic strategies for both immediate and delayed implant placement. In immediate implant placement, these intermediate abutments may be used as adjuncts to ridge preservation and reconstructive procedures by facilitating provisional restoration and supporting peri-implant tissue stability. In delayed implant placement, they may promote bone preservation between adjacent implants, potentially reducing the remodeling associated with repeated retrieval and insertion of prosthetic components directly onto the implant platform. This therapeutic strategy may help maintain stable marginal bone levels, support long-term peri-implant tissue health, esthetics, and, in specific situations, compensate for suboptimal implant position.