Transferring the Emergence Profile from the Provisional to the Final Restoration

Tooth morphology fusion technique is more accurate than conventional technique in transferring morphology of provisional to definitive screw-retained, implant-supported crown: A preliminary intervention study

PURPOSE

To compare the accuracy of the tooth morphology fusion (TMF) digital technique and customized impression transfer coping (conventional) technique when transferring the morphology of a provisional crown to a definitive screw-retained implant-supported crown.

METHODS

Six cases of partial edentulism (one anterior and five posterior) treated with oral implant placement in our clinic for the loss of three or fewer teeth in the maxilla or mandible between April 2017 and September 2018 were included. After implant placement and re-entry surgery, provisional restorations were made and adjusted to obtain the ideal morphology. Two definitive restorations were constructed by transferring the complete morphology of the provisional restorations, including the subgingival contour, using the TMF digital and conventional techniques. Three sets of surface morphological data were obtained using a desktop scanner. The three-dimensional total discrepancy volume (TDV) between the provisional restoration (reference) and the two definitive restorations was digitally measured by overlapping the surface data of the stone cast using the Boolean operation. Each TDV ratio (%) was calculated by dividing the TDV by the volume of provisional restoration. The median TDV ratios for TMF and conventional techniques were compared using the Wilcoxon signed-rank test.

RESULTS

The median TDV ratio between provisional and definitive restorations constructed using the TMF digital technique (8.05%) was significantly lower than that obtained using the conventional technique (13.56%, P < 0.05).

CONCLUSIONS

In this preliminary intervention study, the TMF digital technique was more accurate than the conventional technique for the transfer of morphology from provisional to definitive prosthesis.

Interdisciplinary Management of Bilateral Congenital Lateral Incisor Agenesis

Management of lateral incisor agenesis is a real challenge and needs a strong collaboration between surgical, aesthetic, and orthodontic dentistry. This case report managed upper lateral incisor agenesis with an orthodontic treatment leading to open spaces and placement of cuspids in lateral incisor area to avoid implant placement in maxillary anterior region. Temporary rehabilitation phase, using resin injected tray and removable partial denture, has been placed to maintain mesiodistal dimensions and restore aesthetic during pre-implant analysis and osseointegration. Once osseointegration was fully obtained, keratinized tissue augmentation has been obtained using connective tissue graft. Then, temporary implant fixed crowns allowed soft tissue modeling during interim rehabilitation. Finally, screw-retained permanent crowns were placed to fully restore aesthetic and function. This case goal was to optimize final results and reach patient complete satisfaction using orthodontic treatment combined with implant rehabilitation, and coupled with interdisciplinary management and well-time sequencing treatment.

Use of polyvinyl siloxane to maintain peri-implant submucosal contours on removal of screw-retained implant-supported restorations

When submucosal screw-retained implant-supported restorations are removed for a short period, the soft-tissue contours collapse, which can affect treatment expediency and patient comfort when restorations are reinserted. This technique involves the fabrication of a polyvinyl siloxane submucosal template to help mitigate the soft-tissue collapse and its potential sequelae. This method of maintaining peri-implant soft-tissue contours is achieved through a quick succession of steps: removing the screw-retained implant prosthesis, drying the soft tissue thoroughly, injecting light-bodied fast-set polyvinyl siloxane directly into the implant fixture of the internal connection implants and the screw channel for external connection implants together with the remaining submucosal areas, allowing the polyvinyl siloxane submucosal template to polymerize undisturbed, and removing it when ready to replace the prosthesis.

Copy-paste concept: Full digital approach in the management of gingival emergence profiles

OBJECTIVE

Obtaining a perfect integration of a prosthetic rehabilitation on natural teeth and implantys in the esthetic zone requires a deep knowledge of the biological processes and a clear understanding of the characteristics of the restorative materials. Once the soft tissue profile has been created with the placement of a temporary prosthesis, the ability to accurately transfer information about the tissue profile and the contour of the restoration for the fabrication of the definitive crowns can be challenging.

CLINICAL SIGNIFICANCE

This paper illustrate the copy paste full digital workflow, a simple protocol that allows to create definitive restorations by making an exact copy of the temporary prosthesis that has been placed in function in the patient's mouth.

Influence of Angulation in Cervical Prosthetic Emergences Relative to the Gingival Tissue of Teeth Treated under the Biologically Oriented Preparation Technique (BOPT)

Background: The objective of this study was to digitally evaluate the effect of the cervical emergence of restorations in terms of gingival tissue volume. Materials and methods: In this study, 31 upper front teeth (from canine to canine) were selected and prepared using the biologically oriented preparation technique (BOPT). Each tooth had undergone a change in its provisional process with different emergence profile angles: 30° and 60°. Each sample was digitalised (STL file) using an intraoral scanner. By using various pieces of manipulation software for STL files, a volumetric analysis protocol was carried out. Changes in gingival thickness and position were measured at the buccal and the lingual positions. Results: By increasing the angulation of the emergence profile to 60°, the gingival thickness increased by 0.255 ± 0.381 mm (p = 0.001; t-test) at buccal and by 0.038 ± 0.381 mm at lingual (p = 0.600; t-test). In relation to the gingival height, at buccal, there is an apical displacement of 0.262 ± 0.246 mm (p = 0.001; t-test), and at lingual, there is an apical displacement of 0.390 ± 0.279 mm (p = 0.001; t-test). It was shown that an increase in the provisional emergence profile angle significantly diminishes the gingival height while significantly increasing gingival thickness. The Pearson’s correlation coefficient, r = 0.636, was moderately high and significant (p = 0.001; Pearson). Conclusions: The soft tissue surrounding the BOPT restored tooth evolved according to the prosthetic emergence angle of the provisional restoration, enabling us to plan for an apico-coronal and bucco-lingual displacement of the gingival tissue prior to the definitive restoration.

Volume of unsupported peri-implant soft tissue over time: A cross-sectional observation study

STATEMENT OF PROBLEM

Supraimplant emergence profile changes have revealed that, when not supported, peri-implant soft tissue collapses. However, this phenomenon has not been described qualitatively and quantitatively in 3 dimensions.

PURPOSE

The purpose of this cross-sectional clinical study was to analyze changes in the supraimplant emergence profile digitally over time when the peri-implant soft tissue was not supported.

MATERIAL AND METHODS

A data set consisting of 16 participants with 16 implants was used. After removal of the healing abutment or the interim restoration, 4 intraoral optical impressions were made successively on the patient to record the supraimplant emergence profile at 4 different times: 0 second (T₀), 30 seconds (T_{0.5 min}), 2 minutes (T_{2 min}), and 5 minutes (T_{5 min}). The supraimplant emergence profile surfaces obtained were closed with a 3D meshing software program (Meshmixer) to obtain the volume of the supraimplant emergence profile at each time. The reference volume at T₀ (Vol T₀) corresponded to the volume created during the mucosal healing phase, which, theoretically, should be preserved for the fabrication of the definitive crown. The different volumes (Vol T_{0.5 min}, Vol T_{2 min}, and Vol T_{5 min}) were compared with Vol T₀ to analyze the volumetric changes, kinetics, and topography of this variation by using a 3D visualization and analysis software program (Avizo). A nonparametric Wilcoxon test for paired samples was used for comparison.

RESULTS

The supraimplant emergence profile volume decreased by an average of 5% at 30 seconds (P<.001), 10% at 2 minutes (P<.001), and 14% at 5 minutes (P<.001).

CONCLUSIONS

The supraimplant emergence profile collapsed significantly in 3D when unsupported for 30 seconds or more.

Digital Custom Impression Technique to Record Emergence Profile and Fabrication of an Esthetic Implant Supported Restoration

One of the challenges in esthetic implant supported restorations is to replicate the emergence profile of soft tissue contours created by provisional restorations. Various analog techniques have been used to achieve the most esthetic and natural emergence profile in final restorations. The evolution of digital dentistry has made dentistry easier and efficient albeit with a learning curve. The technique described here uses digital technology to describe a complete digital workflow from the provisional stage to the final restoration.

Digital protocol for creating a virtual gingiva adjacent to teeth with subgingival dental preparations

PURPOSE

This article describes a digital technique used to record gingival emergence profiles modeled for the prosthetic restoration of teeth prepared using biologically oriented preparation technique (BOPT).

MATERIALS AND METHODS

The description of the technique of intraoral recording, manipulation of digital files, and chairside protocol of prosthetic restorations is developed in the present manuscript on two anterior teeth treated with vertical and subgingival dental preparations for restoration with ceramic crowns. The manipulation of the digital files registered with an intraoral scanner with software that allows its alignment (best-fit) and the performance boolean of operation manages to create a virtual gingival emergency like the one it presents when it is adapted on the cervical part of the interim prosthesis.

CONCLUSIONS

The technique allows the dentist and laboratory technician to obtain a digital reproduction of the subgingival soft tissues around the prosthetic crown, unaffected by the collapse of the gingival sulcus when the provisional crown is removed, as well as an exact copy of the provisional restoration, making it possible to fabricate a definitive prosthesis that ensures precise anatomy, and so good compatibility with periodontal tissues.

Clinical outcomes of using a prosthetic protocol to rehabilitate tissue-level implants with a convergent collar in the esthetic zone: A 3-year prospective study

STATEMENT OF PROBLEM

Whether increasing the space for peri-implant soft tissues by using implant systems with conical or convergent transmucosal components would improve tissue stability and esthetics is unclear.

PURPOSE

The purpose of this prospective clinical study was to evaluate the clinical and esthetic outcomes of using tissue-level implants with a convergent collar in the esthetic zone that had been rehabilitated following the biological oriented preparation technique (BOPT) approach after a 3-year follow-up period.

MATERIAL AND METHODS

Sixteen participants with at least 1 nonrestorable tooth in the maxillary anterior region or with congenitally missing maxillary lateral incisors were enrolled, and tissue-level implants with a convergent collar were inserted 3 months after extraction. The implants were restored with cemented single crowns designed according to the BOPT protocol. Bone resorption and the pink esthetic score were evaluated over a 3-year period.

RESULTS

Fifteen participants (mean age: 54.6 years) were evaluated over the 3-year period (total: 16 implants). One participant with 1 implant relocated dropped out of the study. The 3-year implant cumulative survival rate was 100%. The mean ±standard deviation bone-level change was 0.071 ±0.11 mm. The mean pink esthetic score was 8.5 ±1.59, range 4-10.

CONCLUSIONS

The use of the BOPT protocol to restore tissue-level implants with a convergent collar achieved good esthetic results and maintained stable soft and hard peri-implant tissues.

Emergence profile customization technique during implant transfer

This case report aimed to describe the clinical considerations in oral rehabilitation with prostheses on implants in the anterior region, using emergence profile customization technique during implant transfer. A patient presented with a missing left upper central incisor and with not satisfactory esthetic in the other upper incisors. After diagnosis, a treatment plan was elaborated: implant placement in this region; ceramic laminates for teeth 11 and 22, and full crown for tooth 12. During the impression procedure, the implant transfer was customized by copying the gingival profile. The prostheses were made using IPS e.max ceramic system and luted with resin cement. The patient was submitted to annual follow-up examinations that did not show any irregularity or deficiency in the prostheses. The technique performed is a viable alternative that can be used in oral rehabilitation with implants involving anterior teeth because it allows a predictable level of adaptation.

An implant impression technique involving abutment transition from interim prostheses to definitive restorations in the esthetic zone

This article presents an impression technique involving transfer of the position of implants and the emergence profile of splinted interim prostheses fabricated on nonindexed interim abutments to definitive single crowns fabricated on indexed abutments.

Soft Tissue Contour Impression with Analogic or Digital Work Flow: A Case Report

Purpose: Transferring precise information to the dental laboratory is one of the key factors to achieving clinical success. The aim of the present study was to describe classical and digital work-flows used to rehabilitate an implant with a convergent collar in the aesthetic zone following the BOPT (biologically oriented preparation technique) approach and to report the three years follow-up outcomes of two patients rehabilitated following such procedures. Materials and methods: Two central incisors of two different patients were rehabilitated with a tissue-level implant with a convergent collar and, after a provisional and healing phase, one implant was “impressed” using a classical workflow and one using a digital one. The primary outcome measured was the mean bone loss. An intraoral radiograph was taken at crown delivery and at the three years follow-up visit. Secondary Esthetic outcomes pre-op and post-op were evaluated using the PES (pink esthetic score). Results: At the three years follow-up visit, radiographic analysis showed no signs of bone resorption. For the analogic procedure, the pre-and post-op PES scores were 8, whereas for the digital procedure the pre-op PES score was 4 and a post-op score of 9 was obtained. Conclusions: classical and digital work flows succeeded in giving precise and complete anatomical information of implant position, including the soft tissue contour. Minimum bone loss and an esthetic success were obtained in both procedures.

Digital transfer of the subgingival contour and emergence profile of the provisional restoration to the final bone-anchored fixed restoration

PURPOSE

This report was written to introduce an attempt at clinical application of our newly developed digital workflow to reproduce the morphology of the subgingival contour and the emergence profile of the provisional restoration within the final bone-anchored fixed restoration, using a bounded unilateral edentulous case.

METHODS

This digital workflow involves superimposition of the composite images of two specific types of working casts onto the working cast for the provisional restoration namely, a split cast screwed with a titanium base and a split cast screwed with a provisional restoration and integrating these with the whole intraoral surface image, in which the provisional restoration was present. The final restoration fabricated using this technique could be installed without any clinical problems. The results of in silico analysis revealed that the cubic volume ratio of the total discrepancy between the provisional and the final restorations was only 2.4%. Further, sufficient oral hygiene was maintained and the patient was satisfied with the outcome of the treatment.

CONCLUSIONS

This technical report suggests that our newly developed digital workflow provided clinical applicability and may enable accurate transfer of the morphology of the subgingival contour and emergence profile of the provisional to the final bone-anchored fixed restoration.