CAMLOG Special Issue – Implant Replacement

Fig. 9: 5.0x13.0mmJ-Series SCREW-LINE implants havebeen placed to the palatal aspect of the sockets. The plat- forms were placed only slightly sub-gingivally. Fig. 10: The channel deficiencies about the implant were filled with Geistlich Bio-Oss ® particles. Fig. 11: The marginal gingiva was mobilized and advanced crestally. A connective tissue graft from the palate was placed over the implant platforms and down under the marginal gingiva. Implant placement Fig. 12: The previously fabricated provisional was test fitted. The labial margins impinged on the soft tissues, which could be expected to swell in the early post- operative phase. Fig. 13: The labial margins were shortened at the gingival, which improved the esthetics. Fig. 15: On removal, the implant platforms were covered with gingiva and peaks of soft tissue remained in the potential embrasure regions. Fig. 17: Screw-retained provisional restorations developed the desired soft tissue “Emergence Profile” and re- established natural form papillae. Healing with provisionals Emergence profile development Fig. 18: The ceramic abutment posts maintain the established subgingival form. Post-operative healing Fig. 14: The provisional restoration functioned well for the healing period of three months. While there is much discussion about ensuring correct mesiodistal and buccolingual placement for an implant, the correct vertical position of the implant platform is critical for ensuring ade- quate soft tissue coverage and developing the optimal emergence profile. In this case, soft tis- sue augmentation over the implant platforms was critical to achieve the desired result. Emergence profile development is where the soft tissues covering the implant platform are re- shaped so they appear as though a tooth is emer- ging from the gingival complex. In Fig. 17 it can be seen that the provisional restoration has squeezed the rounded and slum- ped papillae back into peaks. This needs to be replicated in the final abutment. Fig. 16: Trans-gingival gingivaformers were placed through minor access incisions. Implant level impressions were made at the same session.