Tales from the Bench:
Planning Aesthetic Success with Implants
By Pete Salamanca • Case by Dr. David Shapiro
This quarterly feature will highlight case corrections and tips from the bench that optimize the results learned from cases before you!
 The best way to predict aesthetic success on implant cases is proper tissue contouring and support. When a clinician is able to support the tissue, they can achieve the appearance of a natural tooth and emergence profile that so many clinicians demand. In our experience, the most predictable way to start this process is with a temporary screw retained crown. When using a screw retained temporary, the clinician can blanch the tissue and allow it to heal around the provisional. This will form an ideal socket around the abutment for the lab to follow. Labs will attempt to duplicate this on a model, but there is no way to know if it’s done properly until the seat appointment. When creating the temporary, ensure that adequate space is allowed for the papilla to adapt interproximally. A helpful guideline is to keep the interproximal contact point 4mm above the height of the implant when contacting a natural tooth, 3mm for contacting implant. Once the temporary crown has been seated there is the opportunity to make changes to the emergence profile as well as the ability to control the final aesthetic on the case. No more apples on sticks!
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When the lab fabricates the abutment it is critical to wax it to full contour so the clinician is able to see the final result. |
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After making sure that the sub gingival aspect of the abutment is convex, cutback the wax and drop the margins sub gingivally. |
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We recommend, when creating a custom abutment, adding some opaque to ensure that there is full block out, especially in the aesthetic zone. |
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Once the abutment is blocked out, we have no reservation recommending a cementable all ceramic restoration. We used IPS Empress Esthetic on 6-10 and went with Lava on #11. After the tissue was contoured and supported we were able to achieve healthy papilla, and an ideal emergence profile. |
Implant aesthetics starts in the planning phase as opposed to the restoration fabrication phase. Clinicians who can achieve the undetectable implant, have created a vision that Gold Dust will make a reality!! |
 Gold Dust would like to acknowledge Dr. David Shapiro of West Windsor, NJ. His expertise on the clinical side of implants has greatly expanded the proficiency of Gold Dust Dental Lab’s Implant Team.
Pete Salamanca heads the Gold Dust Dental Laboratory Production Team |
