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Mastering the Emergence Profile Part 1

Updated: Jan 8, 2023

Hi everyone, and welcome to this 3 part series on emergence profile management around dental implants. This is a really important topic that I find is not discussed enough especially on the prosthetic side of implant dentistry. Often implant companies and courses we attend don't focus on this topic enough which in my opinion can make or break your cases and affect long term success.

Emergence Profile of lower molar managed with customized healing abutment at time of surgery. Case by Dr. Mark Bishara

Before we begin into the discussion, we should define what emergence profile is. It can be defined as the contour of a tooth or restoration as it emerges from the gingiva or for implant dentistry, the contour of an implant abutment where it emerges from the implant platform. It is a WHOLE CONCEPT. It's basically how we turn an implant into a natural looking tooth and ideally this should be customized for every restoration we place in the mouth.

Is emergence profile a function of implant diameter? implant placement depth? soft tissue manipulation? all the above? We need to place the implant deep enough for aesthetic reasons but to also create an ideal emergence profile shape of our restoration. If we rely on implant diameter only to create emergence profiles, it can mean less bone around our implant in the long term.

Using a smaller diameter implant means more tissue needs to be pushed to create ideal emergence profile shape. Image courtesy of Dr. Gregori Kurtzman

What are some criteria for success in optimizing our emergence profile?

-Thickness of the gingiva around the implant. The thicker the tissue, the greater barrier for bacterial invasion is around our implant restoration. Typically tissue of 3-4mm thickness is ideal!

-The size of the horizontal cross section of the future crown at the gingival margin. The bigger the cross section of the area, the more tissue that will need to be pushed away to create the emergence profile. If you are using a narrower implant diameter, it may require a deeper placement to account for gradual emergence profile shape.

-The position of the future crown relative the bone. This relates to the appropriate implant placement depth to allow for respect of biological width formation and abutment/crown of appropriate anatomical shape.

An optimal emergence profile helps to support the implant supported crown and prevent potential food trap issues which can be a pathway to mucositis and peri-implant disease. It also allows the patient to maintain an easier hygiene routine around the implant.

Implant on the left is placed at shallow depth. Emergence profile is compromised with potential food trap issues. Implant on the right is placed deep enough to create appropriate emergence profile

Stay tuned for part 2 as we discuss further on how to optimize our emergence profile shapes around dental implants.

To read part 2 of our blog on this topic, click here: Part 2

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