Journal of Dental Implants
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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 99-102

Customized healing abutment: An alternative technique for maintain peri-implant soft tissue and create implant crown emergence profile


1 Department of Restorative Dentistry, Universidade do Estado de São Paulo (UNESP), Faculdade de Odontologia, Araçatuba; Centro Universitário do Norte Paulista (UNORP), Unipós, São José do Rio Preto, São Paulo, Brazil
2 Department of Dental Materials and Prosthodontics, Universidade do Estado de São Paulo (UNESP), Faculdade de Odontologia, Araçatuba, Brazil
3 Department of Restorative Dentistry, Universidade do Estado de São Paulo (UNESP), Faculdade de Odontologia, Araçatuba, Brazil

Date of Submission28-Mar-2020
Date of Acceptance16-Jun-2020
Date of Web Publication18-Dec-2020

Correspondence Address:
Prof. Rodolfo Bruniera Anchieta
Department of Restorative Dentistry, Unesp – Univ Estadual Paulista, Sao Paulo State University, Araçatuba, SP 16015-050
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_7_20

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   Abstract 

The immediate load procedures in immediate implants have become routine in dental offices because of high esthetics demand by clients. Nevertheless, in some cases, it is not possible to perform immediate load procedures. The purpose of this article was describing the technique for creating a customized healing abutment to preserve the contours of peri-implant soft tissues and maximize peri-implant esthetics in immediate implants when it is not possible to place provisional crowns directly onto the implant. This technique is simple and easily performed and is an interesting alternative treatment for maintaining the stability of the peri-implant tissues while the osseointegration time.

Keywords: Emergence profile, healing abutment, implant


How to cite this article:
Anchieta RB, Assunção WG, Endo Hoshino IA, Rocha EP. Customized healing abutment: An alternative technique for maintain peri-implant soft tissue and create implant crown emergence profile. J Dent Implant 2020;10:99-102

How to cite this URL:
Anchieta RB, Assunção WG, Endo Hoshino IA, Rocha EP. Customized healing abutment: An alternative technique for maintain peri-implant soft tissue and create implant crown emergence profile. J Dent Implant [serial online] 2020 [cited 2021 Jan 24];10:99-102. Available from: https://www.jdionline.org/text.asp?2020/10/2/99/303922


   Introduction Top


The use of surgical techniques that favor the immediate rehabilitation of partially edentulous patients such as implants with immediate load or immediate provisional crown are being widely used in clinical routine, particularly in esthetic areas, as tooth loss results in soft-tissue collapse and bone resorption, with the end result of flat anatomical contours. Therefore, preservation of the existing soft- and hard-tissue contours should be the goal of esthetic patient management.[1],[2],[3],[4]

There are many advantages to using immediate provisional crowns after immediate implant placement such as, for example, maintenance of the bone level, preservation of the architecture of the regular gingival concave arch, and soft-tissue maintenance, in addition to the important psychosocial factor that favors patients receiving immediate replacement of lost teeth.[3],[5],[6]

At present, there are many techniques available to clinicians for the placement of immediate single provisional crowns, and the indication of each of these is dependent on the clinical characteristics of each case.[7],[8],[9]

However, the use of techniques of immediate load on implants depends on several requisites[10] such as obtaining satisfactory primary stability (45N/cm2), and the integrity of the dental alveolus walls, which in some situations, limits the replacement of the lost tooth immediately after implant insertion.[10] In addition, for posterior tooth replacement, the immediate load or immediate provisional is not well established.[11],[12]

In this context, the purpose of this article is to describe an alternative technique for the maintenance and preservation of the hard- and soft-tissue contours when the techniques of immediate load or immediate restoration onto implants were not possible.


   Case Report Top


A 45 year old female patient attended the dental clinic, complaining about discomfort and the esthetic appearance of first upper molar. Clinical and radiographic examinations revealed that the upper first molar have periodontal reabsorption and grade II mobility and dental cavity. It was suggested extraction and installation of mmediate implant.

After tooth extraction and drilling, the implant was placed into the septum of alveolus socket [Figure 1] and [Figure 2] achieving 55N.cm of primary stability. After, a square transfer was connected to the implant for impression molding. The transfer adaptation was verified directly on the implant platform [Figure 3]. Then the impression was obtained using a polyvinylsiloxane material in two viscosities (dense and fluid) (Express XT, 3M). The fluid material was injected around he entire transfer, because the correct impression of the limits of the alveolus is necessary for the faithfulness of the copy of the customized healing abutment contours [Figure 4].
Figure 1: Upper first molar with periodontal reabsorption. The treatment indicate was extraction and immediate implant

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Figure 2: Extraction and immediate implant achieving stability of 45Ncm

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Figure 3: Trans-surgery time and implant impression

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Figure 4: Customized healing abutment placed on implant. After, an implant supported fixed provisional prostheses could be used or a partial removable denture

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Then, a standard healing abutment was selected with a diameter corresponding to the implant platform diameter, and height level with gingival tissue [Figure 5]. The complete impressions of the implant and antagonist arch, and the selected healing abutment were sent to the prosthesis laboratory to have the customized healing abutment was fabricated of laboratory acrylic resin. Another healing abutment was selected to be placed on the implant while the definitive part was not yet ready, in order to maintain the space previously occupied by the tooth.
Figure 5: Emergence profile after osseointegration time

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When the customized healing abutment was finished, the contours and polish of the acrylic resin placed around the healing abutment were verified. Following, a torque of 20N.cm was made in the fixation screew, and finally, the access channel screw was sealed with polytetrafluoroethylene tape and composite resin.[13]

Technique

  1. After tooth extraction and drilling for implant placement in the dental alveolus [Figure 1] and [Figure 2], place the square transfer for impression molding and verify its adaptation directly on the implant platform. If direct visualization is not possible, verify the adaptation by means of a radiograph [Figure 3]
  2. Use a polyvinyl siloxane material in two viscosities (dense and fluid) for performs impression. Inject the fluid material around the entire transfer. The correct impression of the limits of the alveolus is necessary for the faithfulness of the copy of the customized healing abutment contours [Figure 4]
  3. After remove the impression from the mouth and then mix dental stone and artificial gingiva appropriate for the definitive cast according to the manufacturer's instructions. Then, select a healing abutment of a diameter corresponding to the implant platform diameter and that will be level with the walls of the alveolus [Figure 5]. The complete impressions of the implant and antagonist arch, and the selected healing abutment were sent to the prosthesis laboratory to have the customized healing abutment was fabricated of laboratory acrylic resin. Select another healing abutment to be placed on the implant while the definitive part is not yet ready, to maintain the space previously occupied by the tooth
  4. When the customized healing abutment is finished, verify the contours and polish of the acrylic resin placed around the healing abutment. Following, check if there are no areas of excessive compression caused by over contouring of the part
  5. Finally, torque the abutment screw and seal the access channel of screw with polytetrafluoroethylene tape and composite resin.[13]



   Discussion Top


Immediate implant placement and placement of a provisional restoration provide comfort and a stable esthetic restoration during the healing phase, reduce the number of surgical visits, and increase patient acceptance for implant treatment.[1],[4] In addition, immediate replacement maintains tooth space and provides the required dental support to the supporting soft- and hard-tissue structures at the recent extraction site.[1],[3],[9]

In some cases this technique of immediate provisional is not possible to be used, mainly when primary stability of the implants was not achieved 6 or for replacement of posterior tooth.[14] For this, the conventional two surgical stage technique needs to be used; however, the benefits of the immediate restorations are not achieved.[1],[2],[6],[15]

The main advantage of the customized healing abutment is take advantage of the gingival contours maintained by the tooth to determine the correct emergence profile and contours of the future prosthetic part, thereby creating a surface with almost the exact dimensions of the lost tooth, when the immediate loading is not possible.[15]

The possibility to create a correct emergence profile allows implant crowns with satisfactory anatomical shape, mainly in the transition area of implant platform and gingival tissue. The correct anatomical shape is important to avoid food accumulation interproximal areas and enhance the esthetics in anterior and posterior region.

Other advantages of the customized healing abutment are the facility for impression and placement of the definitive implant-supported crown, without second-stage surgery.


   Conclusion Top


This technique is simple and easily performed and can be executed by both general clinicians and specialists. It is an interesting alternative treatment for maintaining the stability of the peri-implant soft tissues for a properly implant crown emergence profile while the osseointegration time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Al-Harbi SA, Edgin WA. Preservation of soft tissue contours with immediate screw-retained provisional implant crown. J Prosthet Dent 2007;98:329-32.  Back to cited text no. 1
    
2.
Chiapasco M, Gatti C, Rossi E, Haefliger W, Markwalder TH. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res 1997;8:48-57.  Back to cited text no. 2
    
3.
Schoenbaum TR. Abutment emergence profile and its effect on peri-implant tissues. Compend Contin Educ Dent 2015;36:474-9.  Back to cited text no. 3
    
4.
Rodriguez AM, Rosenstiel SF. Esthetic considerations related to bone and soft tissue maintenance and development around dental implants: Report of the committee on research in fixed prosthodontics of the american academy of fixed prosthodontics. J Prosthet Dent 2012;108:259-67.  Back to cited text no. 4
    
5.
Holt LR. Commentary: Abutment emergence modification for immediate implant provisional restorations. J Esthet Restor Dent 2013;25:108-9.  Back to cited text no. 5
    
6.
Mijiritsky E, Mardinger O, Mazor Z, Chaushu G. Immediate provisionalization of single-tooth implants in fresh-extraction sites at the maxillary esthetic zone: Up to 6 years of follow-up. Implant Dent 2009;18:326-33.  Back to cited text no. 6
    
7.
Parpaiola A, Sbricoli L, Guazzo R, Bressan E, Lops D. Managing the peri-implant mucosa: A clinically reliable method for optimizing soft tissue contours and emergence profile. J Esthet Restor Dent 2013;25:317-23.  Back to cited text no. 7
    
8.
Lops D, Bressan E, Cea N, Sbricoli L, Guazzo R, Scanferla M, et al. Reproducibility of buccal gingival profile using a custom pick-up impression technique: A 2-year prospective multicenter study. J Esthet Restor Dent 2016;28:43-55.  Back to cited text no. 8
    
9.
Wadhwani CP, Piñeyro A, Akimoto K. An introduction to the implant crown with an esthetic adhesive margin (ICEAM). J Esthet Restor Dent 2012;24:246-54.  Back to cited text no. 9
    
10.
Ramachandra SS, Patil M, Mehta DS. Implants placed into extraction sockets: a literature review. Dent Implantol Update 2009;20:1-8.  Back to cited text no. 10
    
11.
Roccuzzo M, Aglietta M, Cordaro L. Implant loading protocols for partially edentulous maxillary posterior sites. Int J Oral Maxillofac Implants 2009;24 Suppl: 147-57.  Back to cited text no. 11
    
12.
Goiato MC, Pellizzer EP, Barão VA, dos Santos DM, de Carvalho BM, Magro-Filho O, et al. Clinical viability for immediate loading of dental implants: part II--treatment alternatives. J Craniofac Surg 2009;20:2143-9.  Back to cited text no. 12
    
13.
Maluly-Proni AT, Anchieta RB, Suzuki TY, Garcia de Oliveira F, Guedes AP, Rocha EP, et al. Sealing the screw access channel with polytetrafluoroethylene tape: Advantages of the technique. Int J Oral Maxillofac Implants 2017;32:1132-4.  Back to cited text no. 13
    
14.
Barewal RM, Stanford C, Weesner TC. A randomized controlled clinical trial comparing the effects of three loading protocols on dental implant stability. Int J Oral Maxillofac Implants 2012;27:945-56.  Back to cited text no. 14
    
15.
Son MK, Jang HS. Gingival recontouring by provisional implant restoration for optimal emergence profile: Report of two cases. J Periodontal Implant Sci 2011;41:302-8.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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