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ePaper created 2016-03-29, 15:23:51 | version 1.38.0
| case report shaping the gingival contour 14 cosmetic dentistry 1 2016 around the abutment teeth was similar to the soft- tissuecollararounddentalimplants.Thefinalimpres- sionwastakeninordertofabricatethemastermodel, whichwouldreplicatethegingivalcontouraccurately (Figs. 30–32). The final all-ceramic restorations were fabricated according to the master model. Completing the final restorations Oncethefinalrestorationshadbeencompleted,the clear transgingival contours of the crowns could be seenandwereconsistentwiththeshapeofthegingi- val collars around the abutment teeth on the master model (Figs. 33–35). During the try-in procedure, the marginal fit, the shape and the contact points, the consistency of the transgingival contours of the res- torations and gingival collars around the abutment teethwereexaminedcarefully.Thetransgingivalcon- toursoftherestorationsshouldmaintaintheshapeof the gingiva, but not increase the pressure, allowing the gingiva to remain healthy and maintaining the contour in the long term (Figs. 36–39). Revisits Theone-weekfollow-upafterplacementofthefinal restorations found that the gingiva was healthy and stable around the crowns. When compared with the preoperativeintra-oralphotographs,theaestheticout- comewasasignificantimprovement(Figs.1,3,40–43). The patient unfortunately did not attend the re- mainderofthefollow-upsuntilsevenyearsafterplace- ment of the final restoration. At this appointment, the examinationrevealedanundesirableoralhealthstatus, with a Debirs Index (+) and Dental Calculus Index (++). Thegingivawasmildlyreddenedandswollen.However, the health of the gingiva around teeth #21, 11 and 12 was better than around any other teeth. Around teeth #21 and 12, the gingiva was healthy and the gingival contour was stable without noticeable gingival reces- sion. Around tooth #11, slight gingival recession was found with slight reddening and swelling of the gin- giva. However, the aesthetic outcome of the modified gingival contour had been maintained (Figs. 44–47). Discussion Shapingthetransmucosalcontouraroundimplants using provisional crowns has been frequently used in implant dentistry. By using an individualised transfer coping, the collar-like soft-tissue contour around an implant can be replicated on the working model ac- curately.3, 16, 17 In this manner, the contour of the final restorationwillfittheexactcontourofthesofttissue, thusassuringthelong-termstabilityoftheshapeand position of the soft tissue around the implant. In this case, the treatment protocol was drawn from the experience of the restorative process of implant-supported crowns. Taking advantage of the relatively deep gingival sulcus and thick biotype, the gingival contours around the abutment teeth were modified by the provisional restorations; therefore, thegingivalcontourwasreshapedin3-Dandtheideal aesthetic outcome was achieved. Throughouttherelativelylong-termfollow-upperiod, the gingiva around the maxillary right lateral incisor and left central incisor with their larger transgingival depth and convexity was quite stable. The stability of the gingiva around these two teeth was greater thanaroundthemaxillaryrightcentralincisorwithits relatively shallow transgingival depth and smaller convexity.Inaddition,thegingivawashealthy,proving the effectiveness of the treatment protocol applied. Fig. 37: The final restoration seated on the maxillary anterior dental arch. Fig. 38: Left lateral view of the patient’s smile after placement of the restoration. Fig. 39: Right lateral view of the patient’s smile after placement of the restoration. Fig. 40: One-week post-op photograph of the maxillary anterior teeth. Fig. 41: Frontal view of the patient’s smile after treatment. Fig. 42: One-week post-op photograph of the left lateral view of the patient’s smile. Fig. 37 Fig. 38 Fig. 39 Fig. 40 Fig. 41 Fig. 42 dentistry 12016