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Dental TribuneAsia Pacific Edition | 3/2016 10 TRENDS&APPLICATIONS Shaping the soft-tissue contour around implants with provisional resin crowns after implant place- menthasbecomeafrequentlyused technique in implant dentistry.1 For most implant-supported restora- tions,there is a 3 to 4 mm transmu- cosalattachmentsurroundingboth the implant and the restoration.2 Therefore,adjusting thesoft-tissue contour by modifying the emer- gence profile of the provisional crowns to optimise the aesthetic outcome has become a regular practice in implant dentistry.3 In consideration of the health of periodontal tissue around natural teeth, the location of the crown margin is preferably placed supragingivally or flush with the gingival margin so that the con- tour of the restoration will not influence the gingival contour.4, 5 However, in the case of covering the original colour of the abut- ment tooth, forming the ferrule, and/or improving retention and resistance form, the crown mar- gin can be placed subgingivally.6 Because the sulcular depth around a healthy natural tooth is around 1 mm, the cervical margin of the crown is usually located 0.5 mm below the free gingival margin.7,8 Thus,un-likeanimplant- supported crown, a tooth-sup- portedcrowncanhardlyinfluence the gingival contour. However, when the sulcular depth of the abutment is suffi- ciently deep, as with a thick gingi- val biotype, it is possible to sculpt the gingival contour around the abutment teeth using provision- al resin crowns. The treatment process will be demonstrated in this article through a typical case with a seven-year retrospective review. Case report A 48-year-old female patient whose general health condition was good, was referred to the Peking University Hospital of Stomatology in Beijing in China in 2008. The patient’s main con- cern was the restoration of her maxillary anterior teeth that had been compromised by severe dental caries and treated with root canal therapy. The patient had no discomfort and desired not only restoration of the de- fective anterior teeth but also an aesthetic outcome. However, fi- nancial limitations meant not all of her dental problems could be addressed. The dental examination re- vealed that tooth #22 was miss- ing and tooth #23 had shifted mesially. In addition, there were visible defects on teeth #21, 11 and 12.Therootsofteeth#21and12were apparently palatally inclined and so were the crowns. Tooth #11 was slightly inclined to the palatal side and so was the crown. During examination of the occlusion, a deep overbite and a large overjet of the anterior teeth became evident. In addition, the contour of the patient’s gingival line was inharmonious. The angle of her mouth was asymmetrical when she smiled (Figs.1–4). Treatment plan For patients with malocclusion and misalignment of teeth, the restorative procedures should be performed once the primary orthodontic treatment has been completed. However, considering the length of treatment and her financial limitations, the patient refused orthodontic treatment and only accepted the restorative treatment. Since the patient’s inharmonious gingival line may have interfered with the final aesthetic outcome, certain meth- ods to improve the gingival con- tour were considered before tooth preparation. Crown lengthening has been widely used for improving the contour of the gingival line.9–11 However, even if the contour of the gingival line could be modi- fied through periodontal surgery from the vertical direction, the palatally inclined maxillary an- terior teeth would cause the incli- nation of the teeth’s long axes in the sagittal direction. Therefore, theidealaestheticoutcomewould be difficult to achieve (Figs.5). In this case, the restoration’s entire labial face needed to be shifted labially so that the height of the gingival contour could be improved (Figs. 6). Therefore, a more suitable treatment option was considered. Duringfurtherexamination,we found that the patient had a thick gingival biotype witha 3mm deep gingival sulcus around the maxil- lary right lateral incisor and max- illary left central incisor and 1 mm deep around the maxillary right central incisor (Figs. 7 & 8). In implant dentistry, when the soft tissue around the implant is of a thick biotype, modifying the con- tour of the soft tissue by shaping the transmucosal soft tissue with a provisional resin crown of a cer- tain shape has been proved to be an effective method for improv- ing the aesthetic outcome.12–15 However,forrestoringdefective natural teeth, there is insufficient clinicalevidencetoprovewhether provisional resin crowns are ca- pable of shaping the gingival con- tour. Such a treatment protocol was deemed worth attempting in the current case. Between BOPT and BTA A case report on shaping the gingival contour around tooth-supported restorations by means of provisional resin crowns By Dr Feng Liu,China 21 22 23 24 17 18 19 20 13 14 15 16 9 10 11 12 5 6 7 8 1 2 3 4 Fig.1:Frontalviewofthepatient’ssmilebeforetreatment.—Fig.2:Pre-opphotographshowingtheocclusalrelationshipoftheanteriorteeth.—Fig.3:Pre-opphotographof themaxillaryanteriorteeth.—Fig.4:Pre-opphotographofthemaxillaryanteriordentalarch.—Fig.5:Theinclinedaxisofthetoothwouldhaveresultedinanunfavourable aesthetic outcome.—Fig. 6: The labial side of the restorations would be shifted labially.—Fig. 7: The probing depth of the gingival sulcus around the maxillary left central incisor was 3 mm.—Fig. 8: The probing depth of the gingival sulcus around the maxillary right central incisor was 1 mm.—Fig. 9: Frontal view of the pre-op model.— Fig.10:Thegingivalcontourwasmarkedonthemodel.—Fig.11:Thegingivalcontourwasmodifiedonthemodel.—Fig.12:Thediagnosticwax-upshowingtheupward-shifted gingival contour.—Fig. 13: Occlusal view of the diagnostic model.—Fig. 14: The diagnostic wax-up showing the labially shifted restorations.—Figs. 15 & 16: The tooth preparation was guided by the silicone index.—Fig. 17: The completed tooth preparation.—Fig. 18: The provisional restorations replicated from the diagnostic wax-up.— Fig.19:The provisional restorations placed in the mouth.—Figs.20 & 21:The gingiva was covered by the labial side of the provisional restorations.—Fig.22:The gingiva was covered by the labial side of provisional restorations (diagrammatic sketch).—Fig. 23: The provisional restorations appeared just as if they had erupted from the gingival sulcus(diagrammaticsketch).—Fig.24:Twoweeksafterplacement oftheprovisionalrestorations,thegingivalcontourhadbegunpreliminaryremodellingandthemargin of the abutment teeth had been exposed. 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