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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 07 Surgery should be driven by prosthetic require- ments. Once surgery is accomplished, it is impera- tive that restorative clinicians understand how to manipulate the peri-implant soft tissues. Allofthistissuemanagementiscriticallyimpor- tant. However, then comes fabrication of the final restoration.Theabutmentmustbedesignedinsuch a way as to conceal the crown/abutment interface. Furthermore, it must allow for adequate crown thicknesstohaveappropriatestrengthtowithstand mastication forces and still remain retentive. The final contours of the crown must be managed in such a way as to blend into the existing dentition. This patient did not have a symmetrical arch form. The lateral incisiors were not bilaterally sym- metrical nor were the incisal edges consistent. Finally,thecolormatchoftherestoration,especially a central incisor, must be as identical as possible to theexistingdentition.Noneoftheseparameterscan be accomplished without precise communication and excellent laboratory workflow. This case was a success based upon all previ- ously described parameters. The gingival con- tour was essentially mirror image identical to the adjacent central incisor. Papillae were intact.12 The laboratory was skilled at modification of the abutment so that the margins were concealed within the sulcus. The axial and incisal contours of theabutmentprovidedadequateclearancesothata proper thickness crown could be developed. This is critical for both esthetics and for long- term strength and stability of the definitive res- toration. The technician selected the appropriate ingot of ceramic material to serve as substrate for the subsequent application of modifying porcelain andsurfacestaining.Finalcolormatchingcouldnot have been accomplished without skilled hands and eyes of a technician at chairside. Close communication and strong laboratory relationships, along with appropriate clinical un- derstanding of soft-tissue management, leads to success. The inconspicuous final result of this case could never have been accomplished without strong support from the dental laboratory._ Note: Dr. Holt would like to extend thanks to the exceptional team at Drake Precision Laboratories forprovidingalllaboratorysupportforthiscase. Fig. 15 Larry R. Holt, DDS, FICD, graduated from the UNC School of Dentistry in 1978. He was in private prac- tice from 1978-2008. Since 2008, he has been the director of clinical education and research at Drake Precision Dental Lab- oratories in Charlotte, N.C. _about the author Fig. 16 Fig. 15_Seating jig. Fig. 16_ Placing abutment with seating jig. Fig. 17_Abutment torqued and ready for crown seat. Fig. 18_Seating crown. Fig. 19_Final restoration at two weeks. Fig. 20_Patient postoperative smile. Fig. 17 Fig. 18 Fig. 19 Fig. 20