Esthetic Considerations for Reconstructing Implant Emergence Profile Using Titanium and Zirconia Custom Implant Abutments: Fifty Case Series Report
Titanium and zirconia custom implant abutments are now commonly used for esthetic implant dentistry. Custom implant abutments allow the clinician to improve an implant's emergence profile, to customize cervical margins in accordance with the anatomy of the natural root, and to compensate for poor implant angulation. All of these are essential for optimum esthetic outcomes. Computer-aided design/computer-aided machining (CAD/CAM) technology allows the clinician to design custom implant abutment configurations and create natural-looking superstructures that are in harmony with the adjacent dentition and soft tissue. The CAD/CAM technique provides precise fit, reduces the cost of the procedure, and eliminates dimensional inaccuracies inherent in the conventional waxing and casting technique. The aim of this report is to describe a simplified technique for reconstructing emergence profiles during implant restoration using milled titanium and zirconia custom implant abutments. The results of 50 consecutive cases are reported.
Figure 1. Straight healing abutments after three months. Figure 2. Treatment removable partial denture used during healing. Figure 3. Implant level impression with impression coping. (a) Showing the coping screwed into implant. (b) A periapical radiograph confirms fit of the impression coping into implant. (c) Impression coping and lab analog captured by a PVS impression. Figure 4. Gingival mask silicone material used. (a) Just enough silicone is added to cover the coping-replica junction. (b) Gingival mask modified on stone model.
Figure 5. Example of full contour tooth wax-up made after necessary modifications to temporary abutment had been made. Figure 6. The silicone index to be used to fabricate a provisional crown and was positioned against the stone model to verify the restorative space. Figure 7. Creating the finish line and final contour of the wax-up cut back. Figure 8. Scanning and milling the abutment. (a) Scanning wax-up. (b) Computer image of the scanned abutment. (c) Definitive milled titanium abutment. Figure 9. The provisional crown made using polymethyl methacrylate. Figure 10. Milled custom abutment screwed into implant and tightened using a torque of 35 Ncm. (a, b) Facial view for milled titanium and zirconia custom abutments.
Figure 11. Polymethyl methacrylate provisional crown reported after cementation. Figure 12. Standard crown and bridge laboratory procedure were followed to fabricate the definitive crown restoration. Figure 13. Peri-implant mucosa adapted to the custom abutment guided by its emergence profile. Figure 14. The final crowns after cementation. Figure 15. The fully healed mucosa around the definitive crown reported after 1 year in function.
Figure 16. Radiographs. (a) Titanium custom abutment at the provisionalization stage. (b) At 12 months at placement of the definitive restoration. (c) Showing the emergence profile that has been transferred to the implant via the custom abutment. Figure 17. The patient was satisfied with the esthetic outcome. Figure 18. Custom abutment can correct implant misangulation.
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