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9. Cement provisional with polycarboxylate
cement (i.e., Durelon or Dentsply Tylok ® ; York,
PA). Tylok may be more ideal for cementation
during surgery, as it is water-soluble.
10. Homecare consists of chlorhexidine used twice
daily, in both the morning and evening. Previ-
Dent ® (Colgate; NY, NY) should be used at bedtime
to help decrease sensitivity. After meals,
the patient should rinse with water or Listerine
to remove excess food particles.
Figure 5: The use of a coarse diamond bur on the tooth
surface to remove the old margin. By doing this procedure
first, there may be less osseous removal after completion of
shaping.
11. At four weeks, the provisionals are either remade
or relined leaving 1 mm of space to allow
for continued biologic width growth in a coronal
direction. No margination of the tooth surface
should take place at this time.
12. At 14 weeks, chamfer margins are placed just
coronal to the gingival collar and impressions
are taken. A recommendation of one #7
SilTrax ® (Pascal Company; Bellevue, WA) cord be
placed in the sulcus for retraction of tissue.
When endodontics is present the new margin
may be placed within the sulcus. In these
cases, a ferrule effect is recommended.
Figure 6: The tooth is grossly smoothed. With the old margin
removed, space for the biologic width is created without
excessive bone removal.
Figure 7: A superfine diamond bur is used to further smooth
the tooth surface. This allows for long-term maintenance of
the tooth.
Figure 8: A diamond round bur #8 is used to create a parabolic
architecture. A parabolic architecture is created to mimic
the soft tissue contours, which are created after the new formation
of the biologic width. The highest point of bone should
be interproximally, as is the soft tissue. The buccal and lingual
bone should be in a more apical position.
Biologic Shaping41