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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 16  |  Issue : 4  |  Page : 386-389

Custom anatomic healing abutments


1 Department of Periodontics, VS Dental College and Hospital, Bengaluru, Karnataka, India
2 Department of Prosthodontics, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
3 Senior Lecturer, Ragas Dental College, Chennai, Tamil Nadu, India
4 Department of Prosthodontics, VS Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission30-May-2015
Date of Acceptance20-Dec-2015
Date of Web Publication28-Sep-2016

Correspondence Address:
Dr. Dhruv Anand
B-280, Sector 26, Noida - 201 301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4052.176518

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  Abstract 

Dental implants with their increasing success rates and predictability of final outcome are fast becoming the treatment of choice for replacing missing teeth. Considering the success of immediate implant placement in reducing tissue loss and achieving good esthetic results, is making it a more popular treatment modality in implant dentistry. Understanding the management of gingival tissues in relation to implants to obtain maximum esthetics is of utmost importance. The use of provisional abutments and immediate temporization has a proven track record of their ability to produce optimal esthetics and to guide the tissue response during the healing phase. With careful patient selection and execution, customized healing abutments can provide an effective method to enhance the esthetic and emergence profile for anterior implant restorations.

Keywords: Esthetics, gingival biotype, healing abutments, temporization


How to cite this article:
Gowda VS, Anand D, Sundar MK, Reveredo AM, Shetty S. Custom anatomic healing abutments. J Indian Prosthodont Soc 2016;16:386-9

How to cite this URL:
Gowda VS, Anand D, Sundar MK, Reveredo AM, Shetty S. Custom anatomic healing abutments. J Indian Prosthodont Soc [serial online] 2016 [cited 2019 Nov 15];16:386-9. Available from: http://www.j-ips.org/text.asp?2016/16/4/386/176518


  Introduction Top


Dental implants with their increasing success rates and predictability of final outcome are fast becoming the treatment of choice for replacing missing teeth.[1],[2] Over the years, clinicians have realized a paradigm shift from osseointegration to esthetic integration. Dental implants have advantages over both conventional fixed and removable prostheses. The preservation of adjacent tooth structures which are lost during other prosthodontic treatment options and their ability to maintain existing alveolar bone are seen as their primary benefits. Considering the success of immediate implant placement in reducing tissue loss and achieving good esthetic results, is making it a more popular treatment modality in implant dentistry.[3]


  Case Report Top


A 45-year-old female patient reported to the Department of Prosthodontics, V.S Dental College and hospital, with the chief complaint of irregularly placed upper and lower front teeth [Figure 1]. On clinical and radiological examination, the patient was diagnosed with pathological migration of the maxillary and mandibular anterior teeth.
Figure 1: Pathological migration of maxillary incisors - Preoperative

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Intraoral examination revealed the soft tissue to be of thin gingival biotype,[4] with the width of keratinized gingiva less in relation to the upper anteriors. Severe spacing was seen between the maxillary anteriors making the gingival margin contours irregular.

Due to the severity of the migration and the periodontal status of the teeth, the option of a conventional fixed partial denture was ruled out. The patient was given the option of an implant supported fixed partial denture or a removable partial denture. The patient opted for the implant supported fixed partial denture. After the treatment plan was explained to the patient in detail, for the first stage of treatment, it was decided to extract the maxillary central and lateral incisors followed by immediate implant (Hi-tech ®, Lifecare ®) placement [Figure 2]. Owing to the thin gingival biotype and inadequate width of attached gingiva, platelet-rich fibrin [Figure 3] according to the recommendations by Choukran [5] was also placed post, to obtain a good soft tissue profile and to establish primary closure.
Figure 2: Immediate implant placement in the maxillary anterior region

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Figure 3: Platelet-rich fibrin

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Satisfactory healing at 14 days and at 2 months after implant placement can be seen in [Figure 4] and [Figure 5].
Figure 4: 14 days postoperative

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Figure 5: 2 months postoperative

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To obtain an ideal gingival emergence profile and improve the esthetics, healing abutments customized [Figure 6] with micro-filled composite (Charisma ® Heraeus dental) were used after the second stage surgery.
Figure 6: Customized healing abutments with nanocomposites

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The implant abutments were surface treated with sand blasting of 150 µ grit to improve the bonding of the composite to the abutments. The micro-filled composites were highly polished to improve the contour and the emergence profile and also to keep plaque accumulation to a minimum. The custom abutments were placed for a period of 2 weeks after which an acceptable gingival profile was obtained. Presence of stippling in the interdental papilla indicated healthy peri-implant tissue [Figure 7] and [Figure 8]. Temporization was carried out with polycarbonate crowns to visualize the outcome of the final prosthesis [Figure 9].
Figure 7: Healed tissues ready for implant prosthesis

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Figure 8: Well contoured interdental papilla

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Figure 9: Postoperative interim prosthesis

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  Discussion Top


Understanding the management of gingival tissues in relation to implants to obtain maximum esthetics is of utmost importance. There is a complex relation among implant position, gingival management at stage-one and stage-two surgery, the position of the gingival margin over the buccal surface of the implant compared to the adjacent natural teeth, component selection, and lip line esthetics. The therapist who understands these relations will know how to mold the gingival tissue around implants to maximize the esthetic result.

The circular shape of prefabricated abutments makes it more unpredictable in molding the tissue to contours similar to that of natural teeth. In this case, to obtain ideal gingival esthetics, the conventional abutments were customized with the help of micro-filled composites. The shape of the micro-filled composite buildup had to satisfy the emergence profile of a natural tooth. To serve this purpose, 4 abutments were surface treated by sand blasting (150 µ grit) to increase the surface area for better micro mechanical bond between composite and the implant abutment surface. Composite resin was incrementally added to customize the emergence profile specific to the site.

Micro-filled composite (Charisma ® Heraeus dental) was used because of its ability to produce a highly polished surface. This aids in prevention of any microbial colonization by the reduction of plaque accumulation and also being an easily cleansable surface. This would contribute to development and maintenance of healthy peri-implant tissues.

Healthy peri-implant mucosa is important to ensure a good emergence profile particularly in the esthetic zone. It plays a role in preventing peri-implant disease by forming a barrier to efficiently protect underlying bone and prevent access for microorganisms. In addition, after the final restoration, time may be required for soft tissue to fill the embrasure, which is more predictable with healthy tissue.[6],[7] [Figure 8] shows adequate interdental papilla, well contoured gingiva, and the presence of stippling and no inflammation, indicative of healthy peri-implant tissue.

The main purpose of immediate implant placement is to concentrate on the hard and soft tissues that must be developed during the treatment as it has to reduce the tissue loss following tooth extraction.[8],[9],[10],[11],[12]

The use of provisional abutments and immediate temporization have a proven track record of their ability to produce optimal esthetics and to guide the tissue response during the healing phase.[13] However, in this case, due to the migration of the teeth to be extracted and the resultant socket position post extraction, immediate provisionalization would have create a gingival architecture not suited to what was needed in the final restoration. The use of custom-shaped abutments gave us the flexibility to mold the healing gingival tissue to obtain an ideal emergence profile with the permanent restoration in mind.


  Conclusion Top


The use of dental implants for replacement of missing teeth has become a predictable treatment modality with high success rates. With careful patient selection and execution, customized healing abutments can provide an effective method to enhance the esthetic and emergence profile for anterior implant restorations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kan JY, Rungcharassaeng K. Immediate placement and provisionalization of maxillary anterior single implants: A surgical and prosthodontic rationale. Pract Periodontics Aesthet Dent 2000;12:817-24.  Back to cited text no. 1
[PUBMED]    
2.
Spear FM. Maintenance of the interdental papilla following anterior tooth removal. Pract Periodontics Aesthet Dent 1999;11:21-8.  Back to cited text no. 2
[PUBMED]    
3.
Kan JY, Rungcharassaeng K, Lozada J. Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. Int J Oral Maxillofac Implants 2003;18:31-9.  Back to cited text no. 3
    
4.
Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: Visual versus direct measurement. Int J Periodontics Restorative Dent 2010;30:237-43.  Back to cited text no. 4
[PUBMED]    
5.
Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e56-60.  Back to cited text no. 5
    
6.
Priest G. Predictability of soft tissue form around single-tooth implant restorations. Int J Periodontics Restorative Dent 2003;23:19-27.  Back to cited text no. 6
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7.
Phillips K, Kois JC. Aesthetic peri-implant site development. The restorative connection. Dent Clin North Am 1998;42:57-70.  Back to cited text no. 7
[PUBMED]    
8.
Lazzara RJ. Immediate implant placement into extraction sites: Surgical and restorative advantages. Int J Periodontics Restorative Dent 1989;9:332-43.  Back to cited text no. 8
[PUBMED]    
9.
Schropp L, Kostopoulos L, Wenzel A. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: A prospective clinical study. Int J Oral Maxillofac Implants 2003;18:189-99.  Back to cited text no. 9
[PUBMED]    
10.
Morton D, Jaffin R, Weber HP. Immediate restoration and loading of dental implants: Clinical considerations and protocols. Int J Oral Maxillofac Implants 2004;19:103-8.  Back to cited text no. 10
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11.
Rosenquist B, Grenthe B. Immediate placement of implants into extraction sockets: Implant survival. Int J Oral Maxillofac Implants 1996;11:205-9.  Back to cited text no. 11
[PUBMED]    
12.
Schwartz-Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: A literature review. J Periodontol 1997;68:915-23.  Back to cited text no. 12
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13.
del Castillo RA. Immediate provisionalization of a single-tooth implant with a temporary cylinder in one surgical appointment. Pract Proced Aesthet Dent 2006;18 (5 Suppl):3-5.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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