Abstract
Asmgle-unit implant can be difficult to restore esthetically. Implant placement and soft tissue management are factors that must be carefully considered. The coronal portion of the implant should be placed 2 to 3 mm apical to the cementoenamel junction (CEJ) of the adjacent teeth and the implant as far labially as the buccal bone will allow.r, 2 A poorly p 1 a ted implant may dictate a ridge lap or other odd-shaped design that may compromise the beauty and cleansability of the restoration. To appear natural, gingival tissues must have a naturally shaped prosthesis. Several companies have introduced anatomic healing abutments or, as generically termed by Misch, “second stage permucosal extensions,“3 which become matrices for the tissue to heal after secondstage surgery. Although these wider abutments are an improvement, they are conical, whereas natural teeth are not. Because the final restoration is unlikely to resemble that shape, a third surgical operation to reshape the gingiva is often required. Temporization of the restoration may be difficult. If the patient has worn a removable prosthesis, the prosthesis must be adjusted to allow space for the healing abutment, which often leaves an unsightly gap at the gingiva. A possible solution would be the placement of a custom provisional restoration at the time of the second-stage surgery. The advantages of placing a custom provisional restoration are as follows. (1) The exact desired emergence profile can be immediately generated to allow the soft tissue to heal to it’s final desired dimensions. (2) A third surgical operation or other soft tissue manipulation can be avoided. (3) The patient’s tooth will be fixed. (4) The provisional restoration can then be customized as necessary during the following few weeks to perfect dimensions and serve as a guide for the technician fabricating the final restoration.4 Progressive bone-loading protocol should be followed.
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