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ePaper created 2017-04-05, 10:28:22 | version 1.38.0
implants 3_2016 C.E. article_inconspicuous anterior implant-supported restorations I I 05 ate lateral pressure is applied with a temporary abutment when natural teeth are on either side of the implant. The adjacent bone height will dictate the level of the papillae assuming the restoration and its associated abutment properly support them.5 Facialcontourcanbemanipulatedtocreate appropriategingivalzenithheightbyincreasingor decreasingfacialemergenceprofile.Increasingthe profile will move the gingival zenith apically and reduction of contour will move the crest incisally.6 Treatment plan consisted of removal of tempo- rary abutment/provisional crown, fabrication of a temporarypartialdenture(Figs.5,6)andplacement ofanappropriatetemporaryabutmentthatdidnot retain a provisional crown (Ankylos sulcus former) (Fig. 7). This sulcus former, as its name implies, would providesoft-tissueemergenceprofilesupport.The partial denture was to be placed to avoid interfer- ence with the sulcus former when fully seated (Fig. 8). Patient was to be recalled in one-week in- tervals to evaluate the response to this treatment. Once healed, a final, customized abutment and cementable all-ceramic crown would be delivered. The plan was followed per previous description. Postoperativevisitswereuneventful.Patientcom- fort was immediate. Tissue health and emergence profile were deemed appropriate at the second week recall visit (Figs. 9, 10). At a subsequent appointment, the sulcus- forming abutment was removed, a closed tray impression coping was placed and an impression (Identium, Kettenbach) was taken for fabrica- tion of final restoration (Figs. 11,12). Appropriate opposing model, bite registrations and facebow accompanied the case to the laboratory. A careful shademapandclinicalphotographywereincluded. Clinically, it was determined that this would be a difficult shade because of surface characteristics andmaverickcolorsoftheadjacentcentralincisor. Arrangements were made to have a laboratory technician available at the delivery appointment. Sulcus former and temporary partial were rein- serted and patient was dismissed and scheduled for delivery appointment. All model work was accomplished. The labora- tory was given the option of fabricating a custom abutment or customizing a stock abutment. This Fig. 3_Provisional lateral intaglio. Fig. 4_Provisional abutment and crown. Fig. 5_Impression for temporary partial. Fig. 6_Temporary partial. Fig. 7_Ankylos sulcus former. Fig. 8_Temporary partial placed. Fig. 9_Tissue healed and emergence profile established at two weeks. Fig. 10_Sulcus former removed. Fig. 3 Fig. 5 Fig. 6 Fig. 7 Fig. 4 Fig. 8 Fig. 9 Fig. 10