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    Abutment Emergence Contours For Single-Unit Implan

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    Abutment Emergence Contours For Single-Unit Implan

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    Abutment Emergence Contours for Single-Unit Implants

    Article  in  Journal of Esthetic and Restorative Dentistry · January 2015


    DOI: 10.1111/jerd.12143 · Source: PubMed

    CITATIONS READS

    13 1,475

    2 authors:

    Todd Schoenbaum Edward J Swift


    Augusta University University of North Carolina at Chapel Hill
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    CONTEMPORARY ISSUES

    Abutment Emergence Contours for Single-Unit Implants


    Author
    TODD R. SCHOENBAUM, DDS*
    Associate Editor
    EDWARD J. SWIFT JR., DMD, MS

    When discussing the emergence contours of the gingiva. If it is too narrow, it will not fully support the
    implant abutment, we must understand that the shape papilla, which will collapse and flatten.
    and dimension of this component will have a significant
    impact on the long-term levels of the peri-implant bone Ultimately, therefore, the emergence contour should be
    and soft tissue. When improperly designed, the biologically driven, its form and shape determined by
    abutment emergence will compromise the blood supply the proximity of adjacent bone and roots with sufficient
    to the area, ultimately resulting in a loss of health and room for blood supply to the soft tissue. The
    volume of the peri-implant tissues. The design of the emergence contours should be kept at least 2 mm from
    emergence profile is most relevant to us as clinicians in the peri-implant bone to minimize bony resorption.
    the creation of implant-supported provisional When we reverse engineer the abutment emergence
    restorations (immediately loaded or delayed). The from the location and dimension of the peri-implant
    provisional restoration emergence will ultimately form bone, keeping 2 mm away from the existing bone, the
    the soft tissue contours. If designed properly, the resulting design is generally quite narrow at the IAJ
    abutment emergence will support the papilla and free (Implant Abutment Junction) and follows an “S” curve
    gingival margin while allowing sufficient space for the shape that enlarges to reach the free gingival margin
    biologic width. This is critical to the long-term stability (Figure 1, point A). When an abutment is
    of the gingiva. If the abutment encroaches on the overcontoured and encroaches on the nearby bone, the
    biologic width of the surrounding bone, it will continue bone will remodel to restore the biologic width,
    to remodel, leading to highly unpredictable (and although the exact distance is variable and patient
    apically displaced) gingival positions. specific (Figure 1, point B).

    In cases where the volume of the peri-implant tissues is Whether the implant neck is straight, flared, or beveled,
    critical to the success of the treatment, it is imperative it appears that the peri-implant tissues maintain a
    that the abutment emergence on the provisional greater volume when the emergence is narrow. It may
    restoration or custom healing abutment be designed indeed be that the oft-reported clinical success of
    properly and allowed to interact with the peri-implant platform switched implant designs owes some part of
    tissues for a minimum of 4 weeks before the definitive that success to the inherently narrow abutment
    impression is made. This will allow a reasonable emergence. This is in addition to moving the IAJ and
    amount of time for the tissue to mature and for the its corresponding inflammatory cell infiltrate medially
    peri-implant periodontal fibers to stabilize. and away from the bone.

    The primary question then becomes, “What exactly is The narrow emergence abutment allows the gingival
    the ideal emergence design?” If the emergence is too connective tissue fibers (primarily circular type) to
    wide, it will lead to apically remodeled bone and mature without forcing the tissues apically as would be

    *Assistant Clinical Professor, Division of Constitutive and Regenerative Sciences, UCLA School of Dentistry, Los Angeles, CA, USA

    © 2015 Wiley Periodicals, Inc. DOI 10.1111/jerd.12143 Journal of Esthetic and Restorative Dentistry Vol 27 • No 1 • 1–3 • 2015 1
    CONTEMPORARY ISSUES

    FIGURE 1. A, A narrow abutment emergence is designed to allow sufficient blood supply to maximize the volume of the
    peri-implant tissues. B, An overcontoured emergence puts pressure on the tissues and will result in an apical repositioning of
    the bone and gingiva. C, The tooth-implant papilla height is determined by the thin spicule of bone attached to the adjacent tooth;
    the narrow abutment emergence helps preserve this bone at its most coronal position. D, The lower position of the interproximal
    bone on the adjacent tooth will result in apical migration of the papilla and open gingival embrasures.

    FIGURE 2. The provisional restoration is designed with a FIGURE 3. In this patient, the provisional restoration is
    biologically driven emergence profile, which is quite narrow, thus delivered immediately following extraction and implant
    allowing increased blood supply and gingival volume. placement. The emergence profile is narrow, and the
    restoration is well out of occlusion in maximum intercuspation
    the case with a flared abutment design. This ring of and excursive movements.
    connective tissue appears to act as a seal and minimizes
    the apical migration of the gingiva. The narrow
    emergence abutment will thus help to maintain the to create an emergence to which the individual patient’s
    interproximal bone at its most coronal position biology might respond favorably. He/she will be forced
    (Figure 1, point C) compared with a wide emergence to design an abutment to support the prosthesis but has
    profile (Figure 1, point D). no way of knowing how the soft tissue will respond.
    Through the use of a provisional restoration with a
    The technician should not be placed in the difficult narrow emergence profile, the clinician can maximize
    position of grinding away stone (physically or digitally) the soft tissue volume and finalize the actual gingival

    2 Vol 27 • No 1 • 1–3 • 2015 Journal of Esthetic and Restorative Dentistry DOI 10.1111/jerd.12143 © 2015 Wiley Periodicals, Inc.
    CONTEMPORARY ISSUES

    implanto-gingival junction around unloaded and loaded


    nonsubmerged implants in the canine mandible.
    J Periodontol 1997;68:186–98.

    Fürhauser R, Florescu D, Benesch T, et al. Evaluation of soft


    tissue around single tooth implant crowns: the pink
    esthetic score. Clin Oral Implants Res 2005;16:639–44.

    Kois J. Altering gingival levels: the restorative connection part


    I: biologic variables. J Esthet Restor Dent 1994;6:3–7.

    Rompen E, Raepsaet N, Domken O, et al. Soft tissue stability


    at the facial aspect of gingivally converging abutments in
    the esthetic zone: a pilot clinical study. J Prosthet Dent
    2007;97:S119–25.
    FIGURE 4. The 82-year-old patient from Figure 3 following 4
    months in the provisional restoration. Note the significant Schoenbaum TR, Chang YY, Klokkevold PR, Snowden JS.
    coronal migration of the gingival positions. Abutment modification for immediate implant provisional
    restorations. J Esthet Restor Dent 2013;25:103–7.
    position before the fabrication of the definitive
    Zetu L, Wang H. Management of inter-dental/inter-implant
    abutment/prosthesis. papilla. J Clin Periodontol 2005;32:831–9.

    Single-unit implant treatment, particularly in the


    esthetic zone, is a struggle for marginal gains. The most Contemporary Issues
    predictable way to design the peri-implant soft tissue Todd R. Schoenbaum
    architecture is to create a provisional restoration with a Continuing Dental Education
    biologically-driven emergence profile (Figures 2–4), UCLA School of Dentistry
    place it into the implant site, and allow the tissues time Box 951668
    to mature. Room A0-121 CHS
    Los Angeles, CA 90095-1668
    Telephone: +1-310-2673380
    SUGGESTED READING
    E-mail: [email protected]
    Cochran DL, Hermann JS, Schenk RK, et al. Biologic width
    around titanium implants. A histometric analysis of the

    © 2015 Wiley Periodicals, Inc. DOI 10.1111/jerd.12143 Journal of Esthetic and Restorative Dentistry Vol 27 • No 1 • 1–3 • 2015 3

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