Soft Tissue Management around Implant in the Esthetic Zone: A Case Report

One of the challenges in restoring anterior space with implant restoration is maintaining the natural looking of peri-implant area. A 48 years old Saudi female came to the prosthodontic clinic complaining from unaesthetic appearance of her upper anterior teeth. After clinical examination, the patient was diagnosed with advanced periodontitis in teeth #12,11,21,22. After discussion with the periodontist, the decision was to extract these teeth and immediately place implants in the sockets of teeth #11 and #22 followed by immediate loading. Implant surgery was performed but primary stability was not gained. The treatment changed to fabricating custom healing abutments to preserve the soft tissue and the use of transitional denture as a temporary restoration. After 3 months, the soft tissue management using provisional restoration with dynamic compression technique and gingivoplasty was done. Then, the use of an indirect-direct technique for transferring and replicating the cervical contours of provisional restorations to a modified impression coping, which is then used to make an impression of both soft tissue contours and implant positions in the dental arch to fabricate the final prosthesis. This method helps to control gingival contour around implant prosthesis to create an emergence profile. It is relatively easy, precise and predictable method for accurate duplication of soft tissue profile. The technique presented differs from other techniques in that it reduces gingival trauma by eliminating the intra-oral use of resin monomer that avoid chemical or thermal insult to the tissues. It also minimizes surgical procedure by remodeling the soft tissue during the healing process to create the proper contour needed. In addition to that, the important advantage is avoiding the possibility of soft tissue collapsing that may occur during the impression procedure, which gives accurate of the peri-implant soft tissue contours. This case report describes the dynamic compression technique with provisional restorations in the esthetic zone and an alternative impression procedure that accurately captures the emergence profile and soft tissue contours around implants after a provisional restoration has been placed.