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implants 3_2016 I C.E. article_ inconspicuous anterior implant-supported restorations Author_Larry R. Holt, DDS, FICD, director of clinical education and research, Drake Precision Dental Labs Inconspicuous anterior implant-supported restorations: Combining clinical and laboratory expertise This article qualifies for C.E. credit. To take the C.E. quiz, log on to www.dtstudyclub. com. Click on ‘C.E. articles’ and search for this edition (Implants C.E. Magazine — 3/2016). If you are not regis- tered with the site, you will be asked to do so before taking the quiz. You may also access the quiz by using the QR code below. _c.e. credit part I 04 I _The ultimate goal of tooth replacement in the esthetic zone is an inconspicuous transition from dental restoration to the patient’s natural, biologic tissues.1 This transition is evaluated at many levels.2 Color and contour of gingiva at the interface must mimic the natural contours and color of adjacent and contralateral teeth. The dental restoration must match contour and blend seamlessly into the existing dentition. Color matching of final crown must be consistent with existing dentition. (hue, chroma and value) This casestudyexploresthemanagementandcorrection of a previously treated implant-retained maxillary central incisor. The patient presented as a healthy, 48-year- old female with no contributory health history to prohibit dental treatment. Recent dental history revealedanAnkylosimplanttoreplacetooth#9had been placed approximately five months prior to this visit. The implant had been uncovered and a tempo- rary abutment was placed. Aridgelapprovisionalrestorationwasfabricated tofitthecoronalportionoftheabutment.Theresult- antprovisionalwasnotonlyunestheticbutalsowas the source of considerable tissue inflammation and patient discomfort (Figs. 1-3). Patient reported dis- satisfaction with the provisional treatment and was seeking a more desirable solution. Clinical evaluation revealed a well-placed im- plant with acceptable position both facio-lingually and mesio-distally.3 Additionally, there was good volumeofsofttissueandridgeformwasideal.4 Sur- geon reported that the implant was well-integrated in bone. There was a poorly adapted provisional restoration over an inadequately contoured provi- sionalabutment.Radiographrevealedexcessacrylic that extended well into the dental sulcus all the way to the implant platform (Fig. 4). This acrylic did not provide any emergence profile support of transmu- cosal tissue. The provisional restoration was poorly adapted to both the abutment and to the ridge crest soft tissue. Intaglio surface was rough and made in such a manner as to create a ridge lap profile. The facial and proximal surfaces of the provisional were fitted over soft-tissue crest. There had been no attempt to modifygingivaltissueemergenceprofileortocreate the environment for inconspicuous transition from restoration to biologic tissues. Techniques for managing emergence profile are well-documented in the literature. Interproximal tissues will point and form papillae when appropri- Fig. 1_Initial appearance. (Photos/Provided by Dr. Larry R. Holt) Fig. 2_Provisional removed. Fig. 1 Fig. 2