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ePaper created 2017-04-05, 10:28:22 | version 1.38.0
implants 3_2016 I C.E. article_ inconspicuous anterior implant-supported restorations 06 I decision was to be based on the trajectory of the abutment relative to the position of the implant. The placement of the implant was ideal and the use of a lab-modified, stock abutment was selected (0 degree Cercon Balance Abutment, Dentsply Implant). Thecontourcorrelationbetweenthesulcusformer and the emergence profile of the stock abutment complement one another. The margins were placed 1 mm subgingivally on facial, mesial and distal. The lingual margin was placed at .5 mm. Once the abutment was perfected, an all-ceramic crown was fabricated (eMax, Ivoclar). This crown was waxed to full contour, and then the facial was cut back to provide a field into which a customized facial surfacecouldbedevelopedfromaddedporcelain.The wax pattern was invested and pressed. The resultant crown was then modified with additional application of porcelain and was left preglazed in anticipation of chairside staining7 (Figs. 13,14). The delivery appointment was uneventful. The lab provided a seating jig that simplified the positioning of the customized abutment (Fig. 15). The abut- ment was torqued to manufacturer’s specification (Figs. 16, 17). The crown was tried in and adjustments were made to proximal contacts and to occlusion. A dental laboratory technician was enlisted to provide custom chairside staining to perfect the color match. Both patient and clinician were satisfied with the resultant restoration (Fig. 18). The patency of the abutment screwchannelwasprotectedwithcompactedsilicone tape,andtherestorationwasseatedwithimplantce- ment (Premier Implant Cement, Premier). Great care was taken to avoid excess cement and to protect the sulcus from any incursion of residual cement extrusion from margins.8 A crown-seating jig wasprovidedbythelaboratorytobeusedforremoval of excess cement prior to seating of the crown. Patient was rescheduled at a two-week interval for a final evaluation and photography. She was ex- tremely satisfied with both the esthetics and comfort ofthedefinitiverestoration.Clinically,therestoration met the criteria for an inconspicuous restoration (Figs. 19, 20). _Conclusion Understanding of the soft-tissue interface with implant-supported restorations is critical, funda- mental knowledge. All practitioners whose goal is to deliver inconspicuous restorations should practice theseconcepts.Thiscasestudyrevealedthestarkcon- trast between tissue-management protocols. There is no place in contemporary implant dentistry for ridgelap crowns assuming appropriate pretreatment parameters are met. The esthetic zone must be evaluated prior to implant placement and any modification of the ridge form should be taken into consideration well in advance of implant placement surgery.9-11 Fig. 11 Fig. 11_Ankylos impression coping placed. Fig. 12_Final impression. Fig. 13_Abutment with soft-tissue moulage. Fig. 14_eMax crown on abutment. Fig. 13 Fig. 14 Fig. 12