DENTAL TECHNIQUE

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A technique to transfer the contours of an interim implantrestoration to the definitive cast

Burak Yilmaz, DDS, PhD

ABSTRACTAchieving proper soft tissue contours with implant restorations is important for successful estheticoutcomes, particularly in the anterior region. In some situations, clinicians may not be able todeliver interim restorations for proper gingival contouring immediately after implant placement orat the uncovering session, but only at the definitive impression session. The described techniqueallows clinicians to transfer the soft tissue contours of an interim implant restoration to thedefinitive cast at the definitive impression session for the fabrication of definitive restorations. Thistechnique may prevent irregular soft tissue contours around definitive restorations at the place-ment session, thereby reducing the number of appointments. (J Prosthet Dent 2015;113:645-647)

Implant restorations are suc-cessful if they mimic naturalteeth in a harmonized softtissue profile.1 This becomesmore critical if the missingtooth to be replaced is in theanterior region. Tooth lossusually results in the collapseof soft tissue, resulting in

improper soft tissue anatomy.2 Hence, the preservationor improvement of the existing soft tissue contoursshould be the goal of implant restoration management inthe esthetic region.

Interim implant restorations help to preserve softtissue contours1-6 immediately after implant placement,at implant uncovering, and even at the definitiveimpression session.7-9 This clinical technique describes amethod of transferring the contours of an interim implantrestoration to the definitive cast for the fabrication of adefinitive restoration with proper emergence profile andcontour.

In some situations, clinicians may not be able toplace an interim restoration immediately after implantplacement or at the uncovering session for propergingival contouring. This may lead to improper softtissue contours around a narrow healing abutment asopposed to a proper, usually larger, emergence profile ofa definitive restoration. Placing a definitive crown with arelatively larger emergence profile compared with anarrow healing abutment may result in soft tissuecomplications, because the wider diameter definitiverestoration may apply pressure on potentially thick softtissue around the healing abutment. This technique mayhelp clinicians fabricate definitive restorations with

fessor, Division of Restorative Sciences and Prosthodontics, The Ohio Sta

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proper soft tissue contours where an interim restorationwas not placed immediately after implant placement oruncovering, but at the definitive impression session. Thetechnique may also help to minimize soft tissue com-plications with a staged contouring of the soft tissues.Even though appointment time at the definitiveimpression session may slightly increase because theinterim restoration is fabricated and the soft tissuecontours are transferred to the definitive cast at thissession, the number of appointments before the defin-itive placement session is reduced when this techniqueis used.

TECHNIQUE

1. Unscrew the healing abutment (Zimmer Dental) forthe fabrication of an interim restoration and prepareto make the definitive impression (Fig. 1).

2. Make the definitive impression with a polyvinylsiloxane (PVS) impression material (Reprosil;Dentsply Intl) and screw the analog to theimpression post (Zimmer Dental). Pour a gingivalcontour elastomeric material (Gingifast Elastic;Zhermack SpA) around the implant analog. Pour

te University College of Dentistry, Columbus, Ohio.

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Figure 1. Healed soft tissue around healing abutment 2 weeks afterimplant uncovering.

Figure 2. Definitive cast with soft tissue material around impressionpost.

Figure 3. Fabricated interim restoration with cervical line drawn. A, Facially. B, Palatally.

Figure 4. A, B, Interim restoration on definitive cast with removed soft tissue material.

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the definitive cast with a Type IV dental stone(ResinRock; Whip Mix Corp) (Fig. 2).

3. While the dental stone sets, fabricate an interimimplant restoration (UTA; UTA Inc). Draw a line onthe interim restoration at the cervical level facially

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and palatally to define the location of the gingivalmargin (Fig. 3).

4. Once the dental stone has set, unscrew the impres-sion post from the analog and carefully remove thegingival contour elastomer material from the cast.

Yilmaz

Figure 5. A, B, Soft tissue material injected around interim restoration up to marked line.

Figure 6. Soft tissue contour of interim restoration replicated on defin-itive cast.

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5. Screw the interim restoration onto the analog (Fig. 4)and pour gingival elastomeric material (GingifastElastic; Zhermack SpA) around the interim restora-tion up to the marked line at the cervical regionto form the gingival contours in the definitive cast(Fig. 5).

6. Once the gingival elastomeric material has set, care-fully unscrew the interim restoration from the analog.Place the interim restoration and dismiss the patientuntil the definitive placement appointment.

7. Start the fabrication procedures of the definitiverestoration on the modified definitive cast withproper soft tissue contours (Fig. 6).

lmaz

REFERENCES

1. Al-Harbi SA. Nonsurgical management of interdental papilla associated withmultiple maxillary anterior implants: a clinical report. J Prosthet Dent 2005;93:212-6.

2. Lam RV. Contour changes of the alveolar process following extractions.J Prosthet Dent 1960;10:25-32.

3. Kan JY, Rungcharassaeng K, Lozada J. Immediate placement and pro-visionalization of maxillary anterior single implants: 1-year prospectivestudy. Int J Oral Maxillofac Implants 2003;18:31-9.

4. Al-Harbi SA, Edgin WA. Preservation of soft tissue contours withimmediate screw-retained interim implant crown. J Prosthet Dent2007;98:329-32.

5. Spyropoulou PE, Razzoog M, Sierraalta M. Restoring implants in the estheticzone after sculpting and capturing the periimplant tissues in rest position: aclinical report. J Prosthet Dent 2009;102:345-7.

6. Ntounis A, Petropoulou A. A technique for managing andaccurate registration of periimplant soft tissues. J Prosthet Dent 2010;104:276-9.

7. Biggs WF. Placement of a custom implant provisional restoration at thesecond-stage surgery for improved gingival management: a clinical report.J Prosthet Dent 1996;75:231-3.

8. den Hartog L, Raghoebar GM, Stellingsma K, Meijer HJ. Immediateloading and customized restoration of a single implant inthe maxillary esthetic zone: a clinical report. J Prosthet Dent2009;102:211-5.

9. Yilmaz B, McGlumphy E, Purcell B. An alternative direct technique for thefabrication of an implant-supported, screw-retained fixed interim restoration.J Prosthet Dent 2012;107:137-9.

Corresponding author:Dr Burak YilmazThe Ohio State University College of DentistryDivision of Restorative Sciences and ProsthodonticsColumbus, Ohio 43210Email: yilmaz.16@osu.edu

AcknowledgementsThe author would like to thank Dr Karnik Shah for his contribution to thismanuscript.

Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.

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