Custom healing abutment in immediate implantation

 

C u s t o m   H e a l i n g   

The concept of the critical and subcritical contours of the implant emergence profile was described by Su et al. who focus on the importance of shaping two different areas of the EP to achieve the desired outcome in the peri-implant tissues. However, there is still much confusion about the subcritical contour design when different soft tissue environments are present. Developing an adequate emergence profile by manipulating the peri-implant tissues should be done during the provisionalization stage. The technique used will depend on the clinical approach for the case, delayed or immediate implant placement, and the need for adjunct soft- tissue enhancement.

This article describes the esthetic biological contour concept (EBC) and explains. the different areas of the emergence profile to help create an esthetic and biologically oriented contour of implant-supported    restorations.

owing to the differences between the peri- implant and periodontal tissues regarding fiber orientation and vascularity . creating a biological stable zone is a must to protect the peri-implant tissue against  various insults during mastication and oral hygiene measures .

the weaker attachment of peri-implant tissue is a risk factor that must be taken into consideration during creation of the EP 

look into that diagram 

if we put too much pressure in the crestal zone , a lateral pressure necrosis could lead to crestal bone resorption . that subsequently will induce gingival recession and a great risk of per-implantitis 

a straight contour of crestal zone should be guaranteed ...

immediate socket sealing with custom healing abutment 

different ready  made healing abutments are present in any implant system 

but unfortunately it is not suitable for every case to support the soft tissue for creating the ideal emergence profile for your natural restoration

lets see a case of immediate implantation with usage of a ready made healing abutment 

post extraction implant placement with healing abutment secured 

as we noticed in this case the ready made healing abutment couldn't support perfectly neither the labial 

.nor the proximal gingival tissues .. that's why we need a custom abutment to fulfill such a purpose 

first method is to use  

immediate temporization with provisional crown after post extraction implant placement is the best way for creating ideal and natural emergence profile 

initial situation

planning of the case 

surgical procedures

emergence profile after 3 months

before and after

on the contrary replacing the same tooth with ready made healing abutment could be tricky and needs    

 more time and maneuvers 

like this case with limited ridge space to replace tooth 32#

the areas highlighted with the green color needs to be supported to ensure ideal papillary regeneration 

tissues are not ideally supported 

final result 

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the second method is by using 

custom healing abutment 

either done with free hand application 

direct free hand application of composite over temporary abutment to create the desired custom shape of the healing abutment 

or using one of the guided templates 

or using the tool from VPI company 

see more about the product in this link 

https://www.vpicervico.com/

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getting your perfect shape after healing 

this is as a hint for our next topic 

how to deal with this with your lab technician 

References :

A New Concept in Maintaining the Emergence Profile in Immediate Posterior Implant Placement: The  - Anatomic Harmony Abutment - Journal of Oral and Maxillofacial Surgery 2016 742385-2392DOI: (10.1016/j.joms.2016.06.184) 

Gomez-Meda, R., Esquivel, J., & Blatz, M. B. (2021). The esthetic biological contour concept for implant restoration emergence profile design. Journal of Esthetic and Restorative Dentistry, January, 1–12. https://doi.org/10.1111/jerd.12714