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ePaper created 2016-06-25, 17:20:45 | version 1.38.0
special feature Nobel Biocare Global Symposium 13 How to optimize the emergence profile An interview with clinician Dr. Léon Pariente by Michael Stuart, Nobel Biocare n According to Dr. Léon Pariente, a leading clinician based in Paris, France, the emer- gence profile matters. In this short interview on the topic, he explains why efforts to op- timize the emergence profile should begin at the planning stage. Nobel Biocare: Dr. Pariente, what are the most important things to consider in work- ing to establish an optimal emergence pro- file? Dr. Léon Pariente: The emergence profile should be considered holistically: It is the portion of the prosthesis that allows the implant to turn into a natural-looking tooth. It is the border between the surgical and prosthetic worlds. An optimal emergence profile gives a smooth transition from the circular implant platform to the natural shape of the tooth at the gingival level. It should be customized for every restoration. To be ideal, it should be considered during the implant planning phase, particu- larly in selecting a suitable implant, both in terms of connection type and platform diam- eter, as well as in determining the implant positioning in all three dimensions. Clinical factors to take into consideration are the thickness of the gingiva in the area of im- plant placement, the size of the horizontal cross-section of the future crown at the gin- gival level, and the position of the future crown relative to the bone. How does the choice of implant affect the emergence profile? Firstly, the discrepancy between the di- ameter of the platform of the implant and the diameter of the cross-section of the fu- ture crown at the gingival level needs to be compensated for by the abutment. The con- tour of the abutment from the platform to the gingival level constitutes the emergence profile. The angle between the platform of the implant and the wall of the abutment should be as wide as possible to avoid creat- ing a bacteria reservoir. In addition, the connection type (exter- nal or internal) and the collar of the implant, whether polished or not, have a direct influ- ence on the depth to which an implant can be placed to protect the surrounding bone from physiological resorption while retain- ing the biological width. Internal connec- tions such as Nobel Biocare’s conical con- nection, which can be placed under the bone level, therefore allow more flexibility when placing the implant. Smaller-platform implants should be placed deeper, leav- ing more vertical room to compensate for the discrepancy in diameter between the horizontal cross-section of the future crown at the gingival level and the platform it- self. Why is it worth investing time and effort in optimizing the emergence profile? An optimal emergence profile supports the gingiva around the implant-retained crown. This prevents the formation of proxi- mal or buccolingual food traps and allows the patient to maintain the required level of hygiene around the implant. Furthermore, it is a prerequisite for the formation of pseudo-papillae in the interproximal spaces. Poor emergence profile design can have con- sequences that can ultimately lead to the loss of the implant. What are the main challenges in establish- ing an optimal emergence profile? The main challenges that prevent a clinician achieving an optimized emergence profile are improper choice of implant diameter or incorrect implant placement depth. Furthermore, in anterior cases, an ideal gingival contour must be created with a pro- visional crown before taking the impression for the final crown. The main challenge in this case can be transferring the soft-tissue contour to the cast accurately. Finally, what are the main misconcep- tions about establishing the emergence profile? Because of the popularity of standard abutments that are cheap and easy to use, people often think that it is very complicated or expensive to create abutments with a customized emergence profile. The accessibility of the NobelProcera solution should make customized abutments the standard of care. 7 Dr. Léon Pariente PEEK performance: In this case, Dr. Léon Pariente used a PEEK Healing Abutment to shape the soft tissue. The lateral view after crown placement shows proper support of the soft tissue. More to explore! In order to see an ideal emergence profile in one of Dr. Léon Pariente’s case reports, scan the following QR code: