A common challenge for restorative dentists is transitioning an implant (circular cross-section) into a crown (triangular, oval, rhomboidal etc. cross-sections). Some dentists spend the time sculpting this emergence profile with an implant provisional, carefully expanding the soft tissue into more natural contours. Other dentists just take the final impression and leave the matter up to their dental lab. More on that in this article.
There are two reasons why I take the time to develop a custom emergence profile for an implant restoration:
(1) The subgingival contours will be easier to clean by the patient and the hygienist. Unnatural contours can introduce obtuse and acute angles that trap plaque/calculus and defy instrumentation. For more info on implant contours and hygiene, check out this article I wrote for RDH Magazine.
(2) The esthetic result will be improved with more natural subgingival contours. Now this is usually pretty subtle, in my opinion. When we’re getting picky about cosmetics, we’ll pay more attention to shade, tooth shape, incisal embrasures, and the like. But we may notice the “fullness” of the gingiva around our implant crown compared with adjacent teeth.
My traditional technique is described here. But I’ll be honest, spending the time and resources to develop an emergence profile can be a little frustrating. I’ve had patients get frustrated with me. “My other implant didn’t take this long to restore,” they might say. I’ve also struggled placing too much or not enough material on the provisional.
My new favorite technique is to use Neoss Esthetiline abutments. These guys figured out that we could use a head start when sculpting emergence profiles with a provisional. They have an abutment with subgingival contours that mimics the cross section of each of the teeth. You can add or subtract if you want, but I’ve never had to.
What’s even better is that they have final abutments that are made with identical contours. Now you don’t have to create a customized impression coping and use a custom final abutment to get your sexy result. Let me walk you through this:
(1) The patient presents with a healing abutment and is ready for impression. BUT WAIT! We’re not just going to take the final impression. We’re going to be super cool and turn that circular tissue profile into the emergence profile of a premolar.
(2) We just pop in a temporary abutment that already has premolar contours, the Neoss Esthetiline temporary for premolars. Also known as a “Tissue Former,” this material can be prepared or bonded to as you like. Incidentally, your implant surgeon can place this for at the time of Stage II surgery and skip the circular healing abutment. The surgeon simply chops down the abutment to the height of the tissue and BINGO, you’ve got a customized healing abutment.
(3) So I build up a temporary tooth on top of the tissue former. Notice that I left the margins of the temporary abutment untouched. I could have prepared those down to the gingiva and extended my temporary and often will do that in the esthetic zone. But this area is invisible for this patient so I left it alone.
(4) After a few weeks of healing and soft tissue maturation, I’m ready to take the final impression. I take a regular implant impression, nothing fancy. I have ordered the final stock abutment that matches the premolar contours of the tissue former. That’s the Esthetiline system: everything matches from temp to final. I can choose to prepare the margins myself or have the laboratory do it. The important thing is that we’ve faithfully replicated the subgingival contours.
(5) The final result. Note the non-circular soft tissue contours that have been developed with stock, prefabricated components. Also note that there are no unnatural sharp angles on the radiograph. We have smoothly transitioned from a circular implant into a premolar without breaking a sweat.
(6) Do the Happy Dance.