J Periodontal Implant Sci.  2011 Dec;41(6):302-308. 10.5051/jpis.2011.41.6.302.

Gingival recontouring by provisional implant restoration for optimal emergence profile: report of two cases

• Son MK
• Jang HS

• KMID: 2094727
• DOI: http://doi.org/10.5051/jpis.2011.41.6.302

Abstract

PURPOSE
The emergence profile concept of an implant restoration is one of the most important factors for the esthetics and health of peri-implant soft tissue. This paper reports on two cases of gingival recontouring by the fabrication of a provisional implant restoration to produce an optimal emergence profile of a definitive implant restoration.
METHODS
After the second surgery, a preliminary impression was taken to make a soft tissue working cast. A provisional crown was fabricated on the model. The soft tissue around the implant fixture on the model was trimmed with a laboratory scalpel to produce the scalloped gingival form. Light curing composite resin was added to fill the space between the provisional crown base and trimmed gingiva. After 4 to 6 weeks, the final impression was taken to make a definitive implant restoration, where the soft tissue and tooth form were in harmony with the adjacent tooth.
RESULTS
At the first insertion of the provisional restoration, gum bleaching revealed gingival pressure. Four to six weeks after placing the provisional restoration, the gum reformed with harmony between the peri-implant gingiva and adjacent dentition.
CONCLUSIONS
Gingival recontouring with a provisional implant restoration is a non-surgical and non-procedure-sensitive method. The implant restoration with the optimal emergence profile is expected to provide superior esthetic and functional results.

Keyword

Dental implants; Dental restoration repair; Gingiva

MeSH Terms

Crowns
Dental Implants
Dental Restoration Repair
Esthetics
Gingiva
Light
Pectinidae
Tooth
Dental Implants

Figure

• 

  Figure 1 The maxillary first premolar was extracted and the implant was placed (A, before extraction; B, implant healed in a semi-submerged manner).

• 

  Figure 2 4 mm solid abutment placed.

• 

  Figure 3 Provisional restoration with an improper tooth contour.

• 

  Figure 4 Provisional restoration with a proper crown contour (A). Composite resin added extraorally to create an appropriate emergence profile (B).

• 

  Figure 5 The provisional restoration was placed.

• 

  Figure 6 An impression was taken when the change in the gingival tissue architecture was evident after 1 month of provisionalization.

• 

  Figure 7 Definitive implant restoration (A). Postoperative facial view of the harmonious gingival tissue complex and adjacent dentition (B).

• 

  Figure 8 Initial X-ray before extraction of the upper right central incisor (A). The initial image showed the original diastema between the incisors. Immediate implant placement with guided bone regeneration after extraction (B).

• 

  Figure 9 The maxillary left central incisor was replaced with an implant (A). Impression coping was placed to make the impression (B).

• 

  Figure 10 Occlusal view of soft tissue cast. Flat and bulky mesial interdental papilla existed between the incisors in the original diastema.

• 

  Figure 11 A temporary abutment was connected to produce the screw-retained provisional restoration.

• 

  Figure 12 To make a triangular formed interdental papilla and proper contoured crown, composite resin was added to the mesial base of the provisional restoration.

• 

  Figure 13 Provisional restoration with a natural emergence profile (A). Provisional restoration was placed for 1 month to reform the gingiva (B).

• 

  Figure 14 Recontoured gingival architecture by a provisional restoration.

• 

  Figure 15 Postoperative facial view.

Reference

1. Andersson B, Odman P, Lindvall AM, Lithner B. Single-tooth restorations supported by osseointegrated implants: results and experiences from a prospective study after 2 to 3 years. Int J Oral Maxillofac Implants. 1995. 10:702–711.

2. Avivi-Arber L, Zarb GA. Clinical effectiveness of implant-supported single-tooth replacement: the Toronto Study. Int J Oral Maxillofac Implants. 1996. 11:311–321.

3. Jemt T, Pettersson P. A 3-year follow-up study on single implant treatment. J Dent. 1993. 21:203–208.

4. Priest GF. Failure rates of restorations for single-tooth replacement. Int J Prosthodont. 1996. 9:38–45.

5. Levine RA. Soft tissue considerations for optimizing implant esthetics. Funct Esthet Restor Dent. 2007. 1:54–62.

6. Garber DA, Belser UC. Restoration-driven implant placement with restoration-generated site development. Compend Contin Educ Dent. 1995. 16:796798–802. 804

7. Neale D, Chee WW. Development of implant soft tissue emergence profile: a technique. J Prosthet Dent. 1994. 71:364–368.

8. Jansen CE. Guided soft tissue healing in implant dentistry. J Calif Dent Assoc. 1995. 23:57–58. 6062 passim

9. Su H, Gonzalez-Martin O, Weisgold A, Lee E. Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int J Periodontics Restorative Dent. 2010. 30:335–343.

10. Wöhrle PS. Nobel perfect esthetic scalloped implant: rationale for a new design. Clin Implant Dent Relat Res. 2003. 5:Suppl 1. 64–73.

11. Kan JY, Rungcharassaeng K, Ojano M, Goodacre CJ. Flapless anterior implant surgery: a surgical and prosthodontic rationale. Pract Periodontics Aesthet Dent. 2000. 12:467–474.

12. Kim SJ, Kwon KR, Lee SB, Woo YH, Choi DG, Choi BB. Maxillary anterior single implant prosthesis. J Korean Acad Prosthodont. 2001. 39:306–312.

13. Paul SJ, Jovanovic SA. Anterior implant-supported reconstructions: a prosthetic challenge. Pract Periodontics Aesthet Dent. 1999. 11:585–590.

14. Garber DA, Salama MA, Salama H. Immediate total tooth replacement. Compend Contin Educ Dent. 2001. 22:210–216. 218

15. Salinas TJ, Sadan A. Establishing soft tissue integration with natural tooth-shaped abutments. Pract Periodontics Aesthet Dent. 1998. 10:35–42.

16. Davarpanah M, Martinez H, Celletti R, Tecucianu JF. Three-stage approach to aesthetic implant restoration: emergence profile concept. Pract Proced Aesthet Dent. 2001. 13:761–767.

17. Saadoun AP, Le Gall MG. Periodontal implications in implant treatment planning for aesthetic results. Pract Periodontics Aesthet Dent. 1998. 10:655–664.

18. Bichacho N, Landsberg CJ. Single implant restorations: prosthetically induced soft tissue topography. Pract Periodontics Aesthet Dent. 1997. 9:745–752.

19. Macintosh DC, Sutherland M. Method for developing an optimal emergence profile using heat-polymerized provisional restorations for single-tooth implant-supported restorations. J Prosthet Dent. 2004. 91:289–292.

20. Biggs WF. Placement of a custom implant provisional restoration at the second-stage surgery for improved gingival management: a clinical report. J Prosthet Dent. 1996. 75:231–233.

21. Spyropoulou PE, Razzoog M, Sierraalta M. Restoring implants in the esthetic zone after sculpting and capturing the periimplant tissues in rest position: a clinical report. J Prosthet Dent. 2009. 102:345–347.

22. Freitas Jünior AC, Goiato MC, Pellizzer EP, Rocha EP, de Almeida EO. Aesthetic approach in single immediate implant-supported restoration. J Craniofac Surg. 2010. 21:792–796.

23. Leziy SS, Miller BA. Sadan A, editor. Developing Ideal Implant Tissue Architecture and Pontic Site Form. Quintessence of dental technology 2007: special 30th-anniversary issue. 2007. Harnover Park: Quintessence Publishing Co.;143–154.

24. Hirayama H, Kang KH, Oishi Y. The modification of interim cylinders for the fabrication of cement-retained implant-supported provisional restorations. J Prosthet Dent. 2003. 90:406–409.

25. Kois JC, Kan JY. Predictable peri-implant gingival aesthetics: surgical and prosthodontic rationales. Pract Proced Aesthet Dent. 2001. 13:691–698.

26. Al-Harbi SA, Edgin WA. Preservation of soft tissue contours with immediate screw-retained provisional implant crown. J Prosthet Dent. 2007. 98:329–332.

27. Ntounis A, Petropoulou A. A technique for managing and accurate registration of periimplant soft tissues. J Prosthet Dent. 2010. 104:276–279.