Hi everyone and welcome back for part 2 of my blog on emergence profile management around dental implants. Since the introduction of dental implants there has been renewed interest in this concept. We as dentists, are attempting to replicate not only the crown but the entire tooth anatomy. If we look at typical cross sections of the tooth it replaces, the circular implant platform must develop into a variety of shapes from the gingiva: triangular, rhomboidal etc
Typically, the apicocoronal positioning of the implant shoulder follows the philosophy: "as shallow as possible, as deep as necessary." This is basically a compromise between esthetics and biological principles. What does this mean? The implant needs to be buried deep enough for esthetic reasons (hiding the titanium gray colour, allowing for adequate space for contouring the tissue and crown shape) but not so deep as to create an area that may violate bone levels on adjacent teeth, anatomy restrictions(Inferior alveolar nerve, sinus limitations) or create unnecessary deep pockets around implant that may make home care more difficult.
How can we routinely generate and record the natural emergence profile around dental implants and transfer this information to our lab predictably?
There are currently a few methods to do this to replicate the soft tissue emergence:
1-You can make your own custom healing abutment chair side by adding composite to a temporary abutment. Keep in mind this should not be cured in wound site intraorally as monomer release can cause an inflammatory reaction and potential bone loss.
2-You can have your lab make you a milled or printed custom healing abutment or temporary crown out of occlusion the next day. This can be an added expense to procedure.
3-Dynamic Compression Technique: This is a technique to apply compression on tissue with over-contoured provisional then allow for gradual reduction of provisional by under-contouring it. As the tissue creeps back , tissue fills in around the ideal contour. This can be challenging in terms of number of visits needed.
I will be discussing how I design my cases in my next blog using the Cervico VPI system which for me has been a game changer in terms of chair side temporary healing abutment fabrication. But before we do this, its important to discuss the peri-implant seal and its function.
The peri-implant seal is what keeps homeostasis of the internal environment in response to challenges from the external environment. What does this mean? Stay tuned for part 3 of my blog :)