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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
Figs. 4a–d Figs. 4a–d Acrylic resin poured into the gap (a). The customized impression coping obtained after resin polymerization (b). The customized coping screwed to the implant maintains the conditioned esthetic contour (c). The customized coping in the definitive impression (d). procedure can be done prior to the clinical appointment to save chair time. At the time of the clinical appointment, the pro- visional restoration is removed from the oral cavity and screwed to the implant an- alogue. A polyether material is then placed into the mixing cup (Fig. 3a) so that the provisional restoration is put into the im- pression material at the level of the pros- thetic emergence profile (Fig. 3b). This generates a static reproduction of the soft tissue and in particular of the sub- gingival portion of the provisional prosthe- sis. After polymerization of the polyether, the provisional prosthesis is unscrewed (Fig. 3c) from the implant analogue and replaced, in the same supporting cup, with the stock hexed transfer coping for the final impression. A space is thus created between the polyether material and the impression transfer coping (Fig. 3d); this space reproduces the morphology of the periimplant soft tissue. Such procedures are more suitable for screw-retained pro- visional restorations because of the simple removal of the provisional prosthesis from the implant analogue in the mixing cup. Next, cold self-curing resin (TEMP RED, Micerium) is poured into this gap and left to set (Fig. 4a). A custom transfer coping for this single implant site is thus obtained (Fig. 4b). This modified transfer coping is then removed and screwed on to the im- plant in the oral cavity (Fig. 4c). The re- sulting device is an exact periimplant soft-tissue replica and fits perfectly to the shape of the marginal mucosa after the soft-tissue conditioning. No compressive efect on the mucosa or impression mate- rial gaps are generated by the rigid resin around the transfer coping as sometimes occurs with the silicone or polyether ma- terials commonly used for precision im- pressions. A conventional impression can then be taken. By means of a custom im- pression device, a definitive impression is obtained, so the customized transfer cop- ing with the resin remains embedded in the impression material on the device (Fig. 4d). Finally, a CAD/CAM abutment can be pro- vided to reproduce the emergence profile obtained with the provisional prosthesis. The definitive restoration will be put into position and naturally follow the scalloped periimplant marginal mucosa (Fig. 5a). A stable outcome can be achieved because of the absence of any soft-tissue compres- sion (Fig. 5b). This method may be used for the restoration of both single and mul- tiple gaps (Fig. 6). Discussion An emergence profile that mimics the natural tooth should be obtained for suc- cessful esthetic implant restoration. Moreover, it allows proper hygiene, which is fundamental for implant maintenance.5 The best way to achieve the correct emer- gence profile is to sculpt the periimplant mucosa by means of a provisional pros- thesis. Only the thick gingival biotype can be manipulated, as postulated by Berglundh et al.3 and Simeone et al.4 In fact, the thin gingival biotype is not 24 — issue 2017 Digital Workflow and Esthetics Article