Hi everyone and welcome to part 3 of the mastering the emergence profile series around dental implants. When we evaluate the peri-implant seal, there are two important considerations. First is the plaque zone which is a zone typically 1-1.5mm and the biologic zone which is 2-3mm. Why is this relevant to us?
We know that teeth and dental implants behave differently. Natural teeth and dental implants have a connective tissue attachment but they differ. Natural teeth have gingival fibers that run perpendicular to the tooth's long axis attaching to the tooth's surface. Dental implants have fibers that run in parallel to the implant's long axis and don't attach to the implant surface.
What does this mean?
Dental implants when they come under attack from bacterial challenges have an easier chance of "implant seal" break down. Once this begins, it also becomes a quicker process around dental implants as compared to teeth. This is why home care and reinforcement of regular routine care is so important.
How does this play into the importance of emergence profile and tissue management?
Since the fibers on natural teeth naturally provide a physical barrier to bacteria invasion because of their perpendicular orientation, this limits the progress of periodontal disease. This makes sense since if you probe around a dental implant, it is much easier to break this implant-tissue seal due to the parallel orientation of the fibers which allows apical progression of bacteria. This is why it is so important as well to PUSH the plaque zone away from the implant-abutment connection and this allows for easier home care for patients.
What about correct abutment height selection?
Placement of the implant at the appropriate depth will depend on many factors. As we discussed in part 1 of this series, having adequate THICK tissue of 3-4mm is crucial for success in maintaining that barrier to bacterial invasion around our implants. Now that you have placed your implant at the appropriate depth and you are communicating with your lab about appropriate emergence profile design and abutment design it is important that we do not cause bone loss by mistakes WE CREATE ! What does this mean?
When we select our abutment, is is important to respect the space for biological width formation. I prefer to use abutments that are 2.5mm in height and taller if the tissue thickness permits it. This gives adequate space for tissue preservation around the dental implant without potential compromise to the bone around the implant-abutment connection. Although some cases that have thicker tissue MAY do well with abutment that have a shorter height (0.8-1.5mm ), thin tissue may suffer bone dieback to re-establish tissue thickness needed around the implant.
Methods to create emergence profile?
I have mentioned briefly a few methods to create the emergence profile around dental implants. The method I currently use is a very creative system that follows the rules I have discussed in creating an ideal emergence profile predictably. The Cervico System allows me to customize the emergence profile chair side extra-orally. For those interested to learn more about this system, please send me an email to: firstname.lastname@example.org and I can send you an article that discusses this system in full detail.
Thanks for reading this series, if you have enjoyed the read, leave me a comment !