So you’ve gone to the trouble of developing a custom provisional implant restoration. You have lovely contours that accurately resemble a tooth and shape the surrounding ginigva. How do you relay this information to the lab?
If you take an impression coping, which is circular, and seat it on the implant, which has anatomic gingival contours, you run the risk of not capturing all of the detail. Sure, you’ll have the basic position of the implant relative to the other teeth, but you may miss some of the gingival architecture that you spent weeks creating.
The gingiva start to collapse immediately after removing an abutment. The deeper the implant, the more rapidly you’ll see gingiva collapsing on top of the platform. Leave the healing/provisional/final abutment off for too long and you’ll need to do Stage II surgery all over again. No fun.
Here is my technique for accurately communicating the contours of your customized provisional to the laboratory. Similar techniques have been published over the years. The earliest example that I have found is by Drs.David Neale and Winston Chee, “The Development of Implant Soft Tissue Emergence Profile: A Technique” in the Journal of Prosthetic Dentistry, 1994.
Here we go:
First, let’s admire our nice customized emergence profile from our customized implant provisional restoration.
Now attach an implant replica to the provisional. Squirt some old PVS impression material or bite registration material into a small cup. I like to use Blu-Mousse (Parkell) because it sets quickly. Sink the replica and provisional into the Blu-Mousse and wait until fully set.
When the Blu-Mousse is set, unscrew the provisional and you will see its contours recorded around the replica. You should now return the custom provisional back intra-orally to support the ginigva while we finish our little project.
Attach the impression coping to the replica and place material in the voids. I’ve seen dentists use flowable composite, acrylic, and pattern resin for this. Personally I like to use GC Pattern Resin (GC America) because it is self-curing and very stable. Paint the resin and allow to set.
You’re done! Now admire your beautiful customized impression coping in all of its glory.