Emergence Profile Research Articles

Use of beta-tricalcium phosphate bone graft in dental implants for bone regeneration

Objective: to avoid alveolar bone loss and prevent bone resorption and implant failure through the use of beta-tricalcium phosphate bone graft. Case Report: 43-year-old patient who underwent dental extraction of the upper right canine due to root fracture; subsequently, a Bicon® dental implant was placed accompanied by a bone regeneration process in the peri-implant space with beta-tricalcium phosphate substitute and collagen plug, preserving the alveolar bone and papillary gingiva. Results: adequate healing was observed, without gingival retraction. When evaluating the final tomography, an increase in bone tissue was observed at the intervention site with greater measurements than the initial ones and without bone resorption. A fixed temporary crown was made on a temporary abutment which allows the soft tissues to be conditioned, improving the emergence profile for the final crown.

Digital articulation of a complete arch fixed implant prosthesis using the implant prosthetic connections: A dental technique

A method for the digital articulation of complete arch digital implant scans using the implant abutment prosthetic interfaces is described. This technique provides an effective and efficient method for articulating digital scans without the need for matching soft tissue references or fiduciary markers. This allows for a streamlined workflow with fewer intraoral scans and can provide a precise replication of the intaglio surface and emergence profile of an existing restoration.

Application of digital technique in shaping of emergence profile for prostheses supported by dental implant

In the field of dental implantology, the design of interface esthetics not only affects the esthetic coutcome, but also affects the health and long-term stability of the tissue around dental implant. Dental implant, bone tissue, soft tissue, and prostheses' morphology are the four critical elements of interface esthetics. The emergence profile located at the junction of these four components is an important form of oral esthetics. With the wide application of digital technique in the field of dentistry, the shaping of emergence profile also involves the application of many kinds of digital approaches. This article intends to make a review of the application of digital technique in rehabilitation of interface esthetics to provide a reference for clinical practic.

Influence of buccal emergence profile designs on peri-implant tissues: A randomized controlled trial.

The prosthetic emergence profile design might be an important factor in postsurgical mucosal recession etiology. Therefore, a restorative buccal emergence profile designed correctly might reduce gingival margin recession. To compare the marginal gingival level and the width/height (W/H) ratio between two profile configurations of single implant-supported restorations at molar sites. Twenty-one patients requiring a single mandibular molar tooth replacement with supracrestal mucosal thickness ≥2 mm were recruited and randomly assigned to a prosthesis buccal emergence profile design based on the buccal mucosal W/H ratio (Test Group) or maintained the original emergence profile of the healing abutment (Control Group). Assessments were made before delivery of the definitive restoration (T0), at prosthesis placement (T1), one (T2), and 12 (T3) months after loading. The gingival margin level change (△GM), initial emergence angle, buccal mucosal W/H ratio, marginal bone loss (MBL), implant failure, and complications were assessed. The gingival recession in the test group (0.13 ± 0.32 mm) was significantly lower than in the control group (0.63 ± 0.38 mm) at T3 (p=0.006). The initial emergence angle in the test group (31.4 ± 7.22 degrees) was significantly lower than the control group (40.0 ± 7.60 degrees) (p=0.025). The W/H ratio in the test group at T2 was significantly higher than at T0 but remained stable thereafter. The W/H ratio presented a continued rising trend in the control group. When the initial supracrestal soft tissue thickness was ≥2 mm, a restorative emergence profile based on the W/H ratio significantly reduced gingival margin recession. An emergence angle of 32.4 degrees showed better behavior in maintaining the gingival margin than 40 degrees. ChiCTR190002210.

Marginal Bone Maintenance and Different Prosthetic Emergence Angles: A 3-Year Retrospective Study.

The aim of the present retrospective study was to assess marginal bone changes around implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Marginal bone levels (MBL) measured at the prosthesis installation (t0) and at the 3-year follow-up visit (t1) were considered. The MBL change from t0 to t1 was investigated. Two groups were considered: Group 1 for restorations with an angle between implant axis and prosthetic emergence profile >30°, and Group 2 for those with an angle ≤30°, respectively. Moreover, peri-implant soft tissue parameters, such as the modified bleeding index (MBI) and plaque index (PI) were assessed. Seventy-four patients were included in the analysis and a total of 312 implants were examined. The mean EA in groups 1 and 2 was 45 ± 4 and 22 ± 7 degrees, respectively. The mean marginal bone level change (MBL change) of 0.06 ± 0.09 mm and 0.06 ± 0.10 mm were, respectively, in groups 1 and 2. The difference in the MBL change between the two groups was not statistically significant (p = 0.969). The MBL change does not seem to be influenced by the emergence angle for implants with a stable internal conical connection and platform-switching of the abutment diameter.

The flat and step (F and S) pontics. Novel pontic designs for periodontally reconstructed sites.

Fixed dental prostheses are a predictable treatment option to replace missing teeth. A periodontal-prosthodontic approach to rehabilitating those areas ensures a predictable way to achieve the desired esthetic and functional results. This is especially important in cases with high esthetic demand. An ideal esthetic result can be achieved by soft tissue overcorrection through periodontal procedures, which reduce the number of conditioning appointments of the pontic sites. Many pontic designs have been described to enhance the appearance of the restored sites. The flat (F) and step (S) pontic designs are a modification of classic pontic approaches. These designs contact the mucosa in a wide area of a previously reconstructed ridge without exerting excessive pressure, reducing the possibility of inflammation, ulceration, and facilitating cleaning. This periodontal-prosthodontic procedure aims to achieve functional and esthetic prosthodontic results in a predictable manner. Understanding which pontic design is recommended in different clinical situations is key for a successful outcome. The F and S pontic designs are recommended to be used in a ridge with optimal soft tissue volume after periodontal reconstruction. The suggested designs provide the clinician with a solution to different clinical scenarios after the periodontal augmentation of the pontic site has been done. The presented pontic designs are indicated in ridges where a previous soft tissue preservation or reconstruction procedure has been done to achieve an optimal soft tissue volume. Modifications to the designs can be done in the interim stage which is later replicated into the final restoration. The combination of periodontal and prosthodontic techniques help to predictably achieve a natural looking pontic emergence profile.

Effect of Flumazenil on Emergence Agitation after Orthognathic Surgery: A Randomized Controlled Trial.

Flumazenil, a gamma-aminobutyric acid receptor antagonist, can promote arousal even under general anesthesia without the use of benzodiazepines. We hypothesized that flumazenil could promote arousal and reduce emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia. One hundred and two patients were randomly allocated to the control or flumazenil group. Saline or flumazenil was administered at the end of the surgery. The incidence of emergence agitation was measured by using Aono’s four-point scale, with scores of 3 and 4 indicating emergence agitation. The primary outcome was the incidence of emergence agitation. Secondary outcomes included duration of emergence agitation and time intervals between the discontinuation of anesthetics, first response, extubation, and post-anesthesia care-unit discharge readiness. The incidence of emergence agitation was 58.3% and 38.9% in the control and flumazenil groups, respectively, but it was not statistically significant. However, the duration of emergence agitation was shorter in the flumazenil group (p = 0.012). There were no significant differences in the time intervals between the discontinuation of anesthetics, first response, and extubation. Although flumazenil did not reduce the incidence of emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia, it can be considered as an option for awakening patients in terms of improving emergence profiles.

Abstract MP43: Motivational Profiles Are Cross-sectionally Associated With Psychological And Physical Health Outcomes Among Young Adult Yoga Practitioners

Introduction: The adoption of mind-body behaviors, such as yoga, in young adulthood may improve cardiovascular health trajectories through psychological (e.g., reduced stress) and physical (e.g., increased activity) pathways. Differences in personal characteristics, such as motivations for practicing yoga, may relate to differing psychological and physical health outcomes. However, little is known with regard to whether young adults’ yoga-related motivations cluster in latent patterns (i.e., motivational underpinning profiles) or if these profiles are associated with psychological factors and physical health behaviors. Hypothesis: Latent class analysis (LCA) will identify unique motivational profiles among a sample of young adults practicing yoga. Young adults whose yoga practice is internally motivated will be more likely to report positive psychological characteristics whereas external motivations for yoga will be more strongly associated with maladaptive physical health behaviors. Methods: Survey data were drawn from the fourth wave of a large, population-based study (Project EAT-IV; Eating and Activity in Teens and Young Adults). A subsample of 297 yoga practitioners (n=297; mean age=30.8±1.7 years; 79.7% female) reported (yes/no) on nine motivations for yoga items and LCA identified four distinct and mutually exclusive profiles based on previously unobserved combinations of internal and external motivational underpinnings. Cross-sectional associations between emergent LCA motivational profiles, psychological factors, and physical health behaviors were determined using general linear modeling (adjusted for gender, BMI, and race/ethnicity). Results: Across motivational profiles, most young adult yoga practitioners were motivated by stress reduction/relaxation and enhanced fitness. However, additional motivations for yoga differed in such that LCA characterized motivational profiles as “Low Appearance, Low Mindfulness” (Class 1; n=77), “Low Appearance, High Mindfulness” (Class 2; n=48), “High Appearance, Low Mindfulness” (Class 3; n=79), and “High Appearance, High Mindfulness” (Class 4; n=93). Having coexistent high mindfulness and low appearance motives (Class 2) was associated with higher body satisfaction in comparison to the other classes (p<0.001). Relative to Class 2, those with low mindfulness motives (Class 1; Class 3) reported less total physical activity (p=0.002) and those with high appearance motives (Class 3; Class 4) reported higher compulsive exercise scores (p=0.002). Conclusions: Yoga’s mind-body health properties may be harnessed to promote cardiovascular health. Although directionality cannot be assessed with this cross-sectional study, findings suggest that yoga programs for young adults emphasize the internal (mindfulness) rather than external (appearance) benefits of yoga to support a healthful practice.

Effect of scan pattern on the scan accuracy of a combined healing abutment scan body system

Statement of problemA recently introduced scan body combined with a contoured healing abutment enables digital scans of the implant while its healing abutment shapes the soft tissue for an appropriate emergence profile. However, information on the effect of different scan patterns on the scan accuracy of this new system is lacking. PurposeThe purpose of this in vitro study was to evaluate the effect of scan pattern on the accuracy of digital implant scans by using a combined healing abutment-scan body system. Material and methodsA combined healing abutment-scan body system was secured on a single implant at the right first molar site in a dentate mandibular model. A master reference model was generated by scanning the model with an industrial light scanner. The model was then scanned with 4 different scan patterns (SP-A, SP-B, SP-C, and SP-D) by using an intraoral scanner (TRIOS 3). Test scans (n=8) were superimposed over the master reference model by using a metrology software, and distance and angular deviations were calculated. Distance and angular deviation data were analyzed with a multivariate analysis of variance and the Tukey honestly significant difference tests for trueness and precision (α=.05). ResultsDistance deviations (trueness [P=.461] and precision [P=.533] deviations) in the scans were not significantly affected by the scan pattern. Scan pattern affected the trueness (P=.001) and precision (P=.002) when angular deviations were considered. In terms of trueness, SP-D resulted in the highest angular deviations in scans (P≤.031), while the difference in deviations in scans obtained by using other scan patterns was not significant (P≥.378). When angular deviation data were considered, SP-D resulted in lower scan precision than SP-A (P=.014) and SP-B (P=.007). The precision of scans using SP-C was similar to the precision of the scans made by using other scan patterns (P≥.055) in terms of angular deviations. ConclusionsThe scan accuracy of a combined healing abutment-scan body system was affected by the scan pattern. The scans performed with SP-D presented the lowest accuracy considering the angular deviation data and, therefore, may be the least favored among the patterns tested for scanning a combined healing abutment-scan body system.

Use of a Rotational Flap with Soft Tissue Graft and Tunneling Technique for Ovate Pontic Site Development for a Highly Esthetic Outcome: A Case Report

The objective of therapy was to replace the missing teeth with a restoration that closely adhered to the natural teeth and soft tissue contour to provide an esthetic outcome. A 19-year-old male reported a failed fixed partial denture (FPD) in the maxillary left central incisor. The abutment extended to the maxillary right central incisor and the maxillary left lateral incisor. Radiographic examination revealed that the neighboring maxillary right central incisor abutment was nonrestorable. The treatment plan was the extraction of the maxillary right central incisor with socket preservation, modification of the pontic sites for placement of an ovate pontic for the replacement of the missing maxillary upper central incisors with an FPD with the maxillary lateral incisors serving as the abutment teeth. The pontic sites were corrected with a U-shaped flap extended 5 mm palatal from the mid-crestal line. The incision was avoided at the interdental papilla area. The facial flap was elevated. The facial soft tissue was vertically tunneled. The flap was flipped into the facial tunnel and stabilized with horizontal nylon matrix sutures. The surgical site was stabilized with a provisional FPD with an ovate pontic. The final restoration was a full zirconia facial veneered FPD. Surgical site showed significant healing with a natural emergence profile, and interdental papillae filling the gingival embrasure, showing no evidence of recession. At the 1-year follow-up, the gingival thickness improved and the pontic emergence profile was natural. A very stable result for soft tissue volume and interdental papillae were seen. According to the result obtained with rotational flap, it can be used for small anterior defects with promising results, without the need for bone graft procedures or additional tissue graft. With proper case selection, the use of a rotational flap with a tunnel technique and an ovate pontic in the anterior esthetic region is an alternative treatment option that can successfully restore masticatory and esthetic function.

On the Differences in the Periodic Behavior of Magnetic Helicity Flux in Flaring Active Regions with and without X-class Events

Abstract Observational precursors of large solar flares provide a basis for future operational systems for forecasting. Here, we study the evolution of the normalized emergence (EM), shearing (SH), and total (T) magnetic helicity flux components for 14 flaring (with at least one X-class flare) and 14 nonflaring (<M5-class flares) active regions (ARs) using the Space-weather Helioseismic Magnetic Imager Active Region Patches vector magnetic field data. Each of the selected ARs contain a δ-type spot. The three helicity components of these ARs were analyzed using wavelet analysis. Localized peaks of the wavelet power spectrum (WPS) were identified and statistically investigated. We find that (i) the probability density function of the identified WPS peaks for all the EM/SH/T profiles can be fitted with a set of Gaussian functions centered at distinct periods between ∼3 and 20 hr. (ii) There is a noticeable difference in the distribution of periods found in the EM profiles between the flaring and nonflaring ARs, while no significant difference is found in the SH and T profiles. (iii) In flaring ARs, the distributions of the shorter EM/SH/T periods (<10 hr) split up into two groups after flares, while the longer periods (>10 hr) do not change. (iv) When the EM periodicity does not contain harmonics, the ARs do not host a large energetic flare. (v) Finally, significant power at long periods (∼20 hr) in the T and EM components may serve as a precursor for large energetic flares.

Operators' Ease and Satisfaction in Restoring Class II Cavities With Sectional Matrix Versus Circumferential Matrix System at Qassim University Dental Clinics.

Objectives: This study aimed to investigate the operator’s ease, satisfaction, and comfort of using a circumferential matrix system and sectional matrix system on the proximal contact points and contours when restoring class II cavities in posterior teeth.Materials and methods: This cross-sectional study was performed at the clinics in the Department of Conservative Dental Sciences, College of Dentistry, Qassim University. A total of 105 dental students randomly participated in this study to restore a class II cavity with direct composite resin restoration. Operators' comfort and satisfaction were evaluated according to their assessment of the contact points they reproduced and the emergence profiles of restorations, using a circumferential matrix system and sectional matrix system.Results: Out of 105 operators, 57 were satisfied with using circumferential matrix bands for most of their cases while 78 of the operators were satisfied with sectional matrix bands. There were no significant differences between operator satisfaction and the use of circumferential matrix band system (P > 0.05) and sectional matrix band system (P = 0.134) but there was a significant difference between difficulty levels in the use of both matrix band systems (P < 0.05; P = 0.000).Conclusion: Circumferential and sectional matrix band systems showed no significant differences with operators' satisfaction during restoring class II cavities in posterior teeth but using a sectional matrix band system was considered easier than using a circumferential matrix band system.

The Aesthetic Contour Graft - Enhancing peri-implant soft tissue contours and pontic sites with guided bone regeneration.

ObjectiveIn this article, we will discuss strategies for enhancing peri‐implant soft tissue contours and pontic sites with hard tissue augmentation.Clinical considerationOne of the keys to the esthetic illusion of an implant‐supported restoration is to create an ideal emergence profile. A critical part of any emergence profile is based on the height and thickness of the tissue surrounding the restoration and whether there are any defects in this tissue. Even when there is adequate bone in which to place implants, if any irregular ridge anatomy that supports this tissue is not corrected, then an unesthetic appearance of the restoration can result due to the lack of soft tissue with which to develop a proper emergence profile.ConclusionMost peri‐implant soft tissue deficiencies represent an underlying bony defect that can be corrected or enhanced through bone augmentation.Clinical significanceTraditional methods of enhancing soft tissue emergence profiles around implants and pontic sites mostly involve the use of soft tissue augmentation techniques. Although there are few reports of the use of bone augmentation for this purpose, soft tissue contours can be enhanced by augmenting the underlying bone contours and, in many instances, may obviate the need for subsequent soft tissue augmentation.

Biomechanical, operative and biological aspects of the cervical margin relocation: a case report

The clinical success of tooth-colored indirect restorations has been confirmed in several studies. However, inlays andonlays restorations in Class II cavities with deep gingival margins can still be considered a clinical challenge. Withthe purpose of facilitating the execution of the operative procedures in intrasulcular margins and reducing the riskof restorative failures, the technique of cervical margin relocation has been explored as a noninvasive alternative tosurgical crown lengthening. This work aims at discussing through a case report the biomechanical, operative andbiological aspects in the treatment of teeth with deep gingival margins. Therefore, given the therapy applied in theclinical case presented, it is concluded that the cervical margin relocation with composite resin is advantageous sinceit eliminates the need for surgery, allowing the implementation of indirect restorations in fewer clinical sessions,not causing damage to periodontal tissues once it provided good finishing and polishing with the establishment ofa correct emergence profile, allowing flawless maintenance of gingival health after one year.KEYWORDSDental restoration failure; Dental marginal adaptation; Dental Cavity Preparation; Composite Resins; Inlays.

Effect of abutment neck taper and cement types on the amount of remnant cement in cement-retained implant restorations: an in vitro study.

PURPOSEThe present study aims to analyze the effect of abutment neck taper and types of cement on the amount of undetected remnant cement of cement-retained implant prostheses.MATERIALS AND METHODSThree neck taper angles (53°, 65°, 77°) and three types of cement (RMGI: resin-modified glass ionomer, ZPC: zinc phosphate cement, ZOE: zinc oxide eugenol cement) were used. For each group, the surface percentage was measured using digital image and graphic editing software. The weight of before and after removing remnant cement from the abutment-crown assembly was measured using an electronic scale. Two-way ANOVA and Duncan & Scheffe’s test were used to compare the calculated surface percentage and weight of remnant cement (α = .05).RESULTSThere were significant differences in remnant cement surface percentage and weight according to neck taper angles (P < .05). However, there were no significant differences in remnant cement surface percentage and weight on types of cement. No interaction was found between neck taper angles and types of luting cement (P > .05). The wide abutment with a small neck taper angle showed the most significant amount of remnant cement. And the types of luting cement did not influence the amount of residual cement.CONCLUSIONTo remove excess cement better, the emergence profile of the crown should be straight to the neck taper of the abutment in cement-retained implant restoration.

A new method of conclusively creating and transferring the emergence profile on single tooth immediate implant restorations: the E-merge protocol.

The purpose of this article is to propose a new protocol for the accurate transfer of the peri-implant soft tissue emergence profile (EP) using a customized healing abutment or a provisional restoration whose shape is integrated into prosthetic design software. The EP of the future restoration is created extraorally with an ideally shaped customized healing abutment or a provisional crown. Before insertion, the latter is screwed into a repositionable analog placed on a specially designed device and scanned with an intraoral scanner (IOS). This repositionable analog (Straumann RB Repositionable Implant Analog, Art. no. 065.0023), whose original purpose is to keep the correct orientation of the implant platform when placed in a printed model, is already available on the market. It is an exact replica of the implant with a corresponding external index. When scanned, it allows the digital transfer of the exact implant position and index. After healing, a full-mouth impression is made with an IOS without removing the customized healing abutment or provisional restoration. The STL files issued from both impressions are merged to produce a digital model used to design the final restoration, which can be inserted at the next appointment. The technique described is simple, predictable, and precise. It does not require a traditional implant level impression or the use of a digital accessory such as a scanbody to transfer the 3D implant position and the peri-implant gingival contour.

Development of emergence profile and soft tissue contour with a customised healing abutment at the time of implant placement: A case report.

Development of emergence profile and soft tissue contour with a customised healing abutment at the time of implant placement: A case report.

Influencing factors and esthetic considerations of emergence profile of implant dentures in the anterior teeth area

The emergence profile of implant restorations plays an important role on the final esthetic outcome. This article intends to review the emergence profile design of implant restorations in the anterior teeth area, and analyse the factors that affect the emergence profile of implant restorations: implant neck design (non-platform-switching bone level implants, platform-switching implants, and soft tissue level implants), implant position and inclination (implant depth, buccal-lingual position, mesiodistal position, and axial inclination), the type of the abutment, quality and quantity of peri-implants soft tissues. The article aims to provide clinical guidelines for the emergence profile design of implant prostheses based on existing literatures and clinical experiences.

A digital workflow for accurately and rapidly creating an immediate provisional restoration with natural emergence profile using extracted tooth.

To describe a digital workflow for creating a provisional restoration by using an extracted tooth rapidly, finally fixing the provisional restoration in the targeted position precisely and preserving the natural emergence profile from the time of provisional restoration to final restoration. CLINICAL CONSIDERATIONS: The use of extracted tooth as an immediate provisional restoration is an effective method for preserving the shape of the emergence profile. However, the existing methods for creating a provisional restoration by using natural tooth are time-consuming and there is no reliable method to precisely attach tooth to temporary abutment. This case demonstrates a new method for using patient's natural tooth as an immediate provisional restoration under a sequence of guides, which significantly reduces the chair-side time and inconvenience for clinicians and patients. Immediate provisional restoration contributes to preserving the soft tissue architecture after post-extraction implant placement, especially when using the patient's tooth as a provisional restoration. Digital technology can help to improve the chair-side clinical efficiency of dentist. CLINICAL SIGNIFICANCE: Maintaining the natural soft tissue architecture is a huge challenge in dental implantology. Use of the extracted tooth as a provisional restoration is likely to achieve an optimal outcome. And digital technology is helpful to the efficiency and accuracy of treatment.

A Biologically Driven Concept to Design the Emergence Profile Around Dental Implants: Surgical and Prosthetic Considerations to Optimize Hard and Soft Tissue Integration.

The emergence profile is a crucial factor in facilitating favorable esthetic outcomes and maintaining peri-implant health and stability. It should be evaluated not simply in terms of morphology but as a clinical variable closely related to material properties and clinical approaches; in this way, this critical factor-which can significantly influence the integration, stability, and preservation of bone and soft tissues-can be comprehensively planned. Soft tissue integration and adherence to prosthetic components are paramount elements in the preservation and protection of bone from contamination and infection. The present narrative paper presents a prosthetic concept suggested as an operative strategy to preserve peri-implant hard and soft tissues and achieve predictable prosthetic outcomes, optimizing soft tissue integration. Achieving an ideal soft tissue seal around implants is paramount in achieving stable restorations and protecting the bone interface from possible contamination and infection.