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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
Drs. Andrea Parpaiola, Luca Sbricoli, Riccardo Guazzo, Eriberto Bressan & Diego Lops, Italy — Dr. Diego Lops MANAGING THE PERIIMPLANT MUCOSA: — A clinically reliable method for optimizing soft-tissue contours and the emergence profile Introduction Distinctive characteristics of the periim- plant mucosa diferentiate it from peri- odontal tissue.1 The diference lies in the absence of cementum. In fact, the colla- gen bands lie diferently at the site of the implant. The fibers are set in the perios- teum at bone crest level and spread par- allel to the implant surface, or they align in broad bands that, in more distant areas, expand almost perpendicular to the im- plant surface. These horizontal fibers seem to bend vertically and appear to run parallel to the implant’s surface in the areas nearest to the implant.1, 2 The connective tissue at the implant inter- face contains a larger amount of colla- gen, but fewer fibroblasts and vascular structures, than the tissue adjacent to natural tooth structure.3 The successful restoration of lost teeth in the anterior region of the mouth has to meet both esthetic and function- al parameters. In addition to the correct placement of the implant fixture, it is essential to achieve a soft-tissue mor- phology that is as physiologically realistic as possible. An impression obtained with standard copings enables the 3-D posi- tion of the implant fixture to be repro- duced on a laboratory model. However, the reproducibility of the periimplant soft tissue is often diicult to control, and this can compromise esthetics in the final implant restoration. Most healing abutments have a cylindrical shape, which is not suitable to reproduce correctly the emerging profile of the natural teeth. The dental technician can model an implant-supported prosthesis with a cylindrical profile or with a more appropriate esthetic profile based only on an assumption of the shape suited to the clinical situation. In fact, final tissue heights of the papillae and buccal gingi- val margins, relative to their pre- implant position, are ultimately dictated by the post-healing levels and position of the interproximal and facial bone. Because of its characteristics, the periimplant mucosa can be modified by a sculpting process based on the princi- ple that soft tissue becomes modifiable after controlled, constant compression. Especially in patients with a thick gingival biotype, this tissue can be manipulated to reproduce the normal scalloped, par- abolic gingival contours. Diferent ap- proaches have been suggested by the current literature on soft-tissue profil- ing.4–6 All of these focus on establishing a contour of the provisional prosthesis that is as accurate and stable as possible so that it can be faithfully reproduced in the definitive prosthesis. The present paper describes a method that has been consolidated over several years of clinical practice for the periim- plant soft-tissue profiling in the anterior areas. By following the procedure de- scribed in the next section, it is possible to recreate, in cooperation with the dental technician, the correct emergence pro- file for both single and multiunit prosthe- ses. 22 — issue 2017 Digital Workflow and Esthetics Article