Heft 19 - Herbst 2001.pdf - Neue Gruppe

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14
of any tooth in the esthetic zone since it re p resents a non-invasive, elegant
method to augment the soft and hard tissues and to counteract the inevitable
post-extraction resorptive pro c e s s .
Another indication for the application of adjunctive soft and hard tissue
p ro c e d u res is the enhancement of the gingival topography by means of
esthetic crown lengthening (19). This pro c e d u re can be employed to corre c t
esthetic problems associated with gingival asymmetry, insufficient clinical
c rown length, and flat gingival contours (20). The main indication for this
p ro c e d u re in conjunction with esthetic implant dentistry is the young patient
p resenting with one or more missing teeth in the maxillary or mandibular
anterior sextants. Although these patients may have completed the active
phase of tooth eruption and facial growth and be ready for implant therapy,
f requently they have not completed the passive phase of tooth eruption. In
these situations the implant should not be placed according to the adjacent
teeth but rather according to the ideal esthetic parameters and an esthetic
c rown lengthening pro c e d u re of the adjacent teeth should be perf o rm e d
either prior to or in conjunction with implant placement. If the implant is
placed according to the adjacent teeth without the benefit of esthetic cro w n
lengthening, the future passive eruption of these teeth will create a gingival
a s y m m e t ry between the implant restoration and the natural teeth, there b y
c o m p romising the esthetic re s u l t .
R E S T O R ATIVE PROCEDURES
Figure 8 A customized metal-ceramic abutment based on the Narrow Neck
framework blank was fabricated. The subgingival ceramic portion of this
customized abutment re c a p t u res the soft tissue contours created by the
provisional restoration
The restorative pro c e d u res are usually initiated after the implants are osseointegrated.
The first and most crucial step is to utilize customized pro v i s i o n a l
restorations to guide the peri-implant soft tissue healing. The pro v i s i o n a l
restoration should incorporate a smooth transition from the subgingival
implant shoulder to the emergence point of the restoration. The pro v i s i o n a l
restoration can be modified during the provisionalization period of 6-8
weeks to gain the desired peri-implant soft tissue contours. Once the pro p e r
soft tissue contours have been achieved with the provisional restoration, the
final restoration can be fabricated. In addition to the implant position and
tooth shade, the final contours of the provisional restoration should be transf
e rred to the laboratory as well. This can be accomplished either with a
customized impression coping replicating the final contours of the pro v i s i o n a l
restoration, with a second master model incorporating the exact contours
of the provisional restoration, or by using the provisional restoration itself
as the final impression transfer coping. These techniques assure that the
final restoration is fabricated with the exact same contours as the pro v i s i o n a l
restoration. The final restoration should preferably be scre w - retained with
Figure 9 The customized abutment was inserted and torqued to 25 N/cm.
The margin for the cemented restoration is located only 1 mm subgingivally