Dentists who combine analog impression and digital scanning techniques with computer-aided design and computer-aided manufacturing technology can develop a prosthetically driven emergence profile for implant-supported restorations. The 6-step technique is detailed in an article published online in The Journal of Prosthetic Dentistry.
Advantages of the 6-Step Technique
- The length of healing abutments can be ignored.
- Sculpting soft tissue is no longer necessary after using the custom healing abutment.
- Custom anatomic abutments can overcome the limitations of stock abutments, which cannot approximate all contours during healing.
- The procedure takes less chair time, and computer-aided design and computer-aided manufacturing technology allows dentists to make a custom abutment or screw-retained implant crown with a definitive emergence profile.
- The technique eliminates laboratory costs and eliminates laboratory errors when the gingival mask can be designed while fabricating the definitive restoration.
- Reducing repeated disconnection of components from the implant also minimizes the loss of peri-implant bone and soft tissue.
Examine and radiograph the implant and obtain a conventional impression and digital scan with an open tray impression coping and scan body. Dentists then pour a stone die and replicate the soft tissue with a gingival polyvinyl siloxane material and use a surgical blade to sculpt it into a definitive emergence profile.
Use a Ti- (titanium) insert and block out resin to obtain a custom healing abutment from the modified model. The abutment would be placed after administrating local anesthetic.
Make a new scan that captures changes made to the silicone material and add it to the initial scan as a gingiva mask in the Chairside Economical Restoration of Esthetic Ceramics (CEREC) software.
Reduce soft-tissue margins in the gingiva mask folder to achieve an emergence profile to match the custom healing abutment.
Design and mill a screw-retained monolithic crown from a lithium disilicate block. Ceramic material is crystallized and glazed. Dentists then bond the monolithic crown to the Ti-insert with a chemically polymerized opaque resin cement.
After the healing period, the final step requires dentists to remove the custom healing abutment and deliver the screw-retained restoration with optimal soft-tissue support.
Original Article
Julian Conejo, Pablo J. Atria, Ronaldo Hirata, Markus B. Blatz. Copy milling to duplicate the emergence profile for implant-supported restorations,.The Journal of Prosthetic Dentistry, 2019 [Article in Press]
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Chiraz Guessaier, CDA Oasis Manager