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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
Fig. 6 Figs. 5a & b Figs. 5a & b Final restoration at baseline (a). Final restoration one year after the prosthesis delivery (b). Fig. 6 Soft-tissue aspect after conditioning with provi- sional crowns for resto- ration with a four-unit partial fixed prosthesis. suitable for sculpting because its com- pression does not lead to a controlled scalloping, but to a high risk of soft-tissue collapse and gingival recession.7 Standard healing abutments and trans- fer copings do not simulate the cross- section of natural teeth8 because they are round. Many authors agree that the final prosthetic rehabilitation must match the intraorally obtained soft-tissue modifica- tions.5, 9–11 Prefabricated provisional crowns cannot mimic the complexity and the vari- ations of human soft tissue. Therefore, only a chairside modification of the provi- sional restoration can accomplish the op- timal result. Moreover, the same authors agree that provisional restoration has to be screw-retained to prevent the irritating side efects of provisional cement on the periimplant soft tissue, especially in situa- tions in which frequent removals of the provisional restoration are required. In addition, crucial for achieving a successful esthetic outcome is the transfer of the impression information to the dental lab- oratory.12 The operator should choose an easy and reproducible technique to trans- fer the emergence profile to the impres- sion and therefore the model cast in order to allow the dental technician to create a suitable contour for the best esthetic out- come of the final restoration. The self-curing resin used for contour- ing the impression coping is common in the dental practice; moreover, it is easy to manipulate and inexpensive. It can be easily poured into the gap between the coping and impression material as long as it is fluid. Because of its low shrinkage, the modified impression coping accurately reproduces the soft-tissue contour obtained with the provisional restoration. Consequently, the exact shape of the resin- generated emergence profile will be transferred to the definitive restoration. Another important advantage of this technique is that the patient is not left without the prosthesis for a long period during the definitive impression proce- dures; in fact, the customized transfer coping can support the periimplant mucosa. Tissue collapse and volumetric changes will be avoided and the soft- tissue sculpting will remain stable. Fur- thermore, the technique presented is easily reproducible and does not require particular operator skills. Conclusion In highly demanding areas, where a good esthetic outcome is as essential as the function of the implant-supported resto- ration, soft tissue can be modified to obtain an optimal emergence profile and gingival contours with a physiological appearance as realistic as possible. The method described allows for faithful re- production of the conditioned soft tissue when the final impression is taken; thus, its reproduction on the definitive resto- ration is possible. The main advantage of this approach is the easy and reproducible use of an inexpensive material that is easily available to clinicians. Editorial note: A list of references is avail- able from the publisher. This article was first published in the Journal of Esthetic and Restorative Dentistry (Vol. 25, No. 5, 2013, 317–23). Article Digital Workflow and Esthetics issue 2017 — 25