The esthetic success of an anterior implant-supported restoration is mostly dependent on having a soft-tissue architecture that is indistinguishable from the adjacent teeth. One of the most important steps to achieve this “esthetic success” is the correct use of the provisional restoration to optimize and properly contour (groom) the peri-implant tissue anatomy.

Once the optimal emergence profile has been developed, we need to communicate and transfer this information properly to the laboratory, unfortunately all implant companies provide stock round impression copings that do not transfer the soft-tissue contours precisely. A simple protocol to communicate this information is described here.

This visual essay walks through a step-by-step description on how to fabricate a personalized impression coping to transfer the peri-implant tissue anatomy properly.

Frontal view of an implant-supported provisional restoration on the maxillary left central incisor after tissue maturation.
Close-up view of the buccal soft tissue depicting proper support of the provisional.
Different views of the provisional restoration secured in an implant analog.
Light body PVS is injected around the emergence profile of the provisional.
The provisional attached to the implant analog is positioned in a dappen dish and heavy body PVS is injected around the analog.
Different views of the provisional inside the PVS after polymerization.
After removal of the provisional restoration verify that the submucosal contours are captured precisely by the light body PVS.
The impression coping is attached to the analog and PATTER RESIN is injected into the area to properly copy the contours impressed by the PVS.
Frontal and lateral view of the personalized impression coping simulating the emergence profile that will support the soft tissue.
Superimposed image of the provisional restoration and impression coping showing appropriate transfer of the emergence profile.
Personalized impression coping attached to the implant in #9 and veneer preparation on #8.
View of the buccal soft tissue with proper support of the personalized impression coping.
Close-up view of the PATTER RESIN with proper support of the soft tissue.
Open tray pick-up impression of personalized impression coping on implant #9 and veneer preparation for tooth #8 utilizing PVS.
Definitive restorations on the master cast.
Layered zirconia crown was bonded to a Variobase on implant #9 and a feldpathic veneer was fabricated for #8 to improve the contours and esthetics.
Frontal view of definitive restorations at 12 weeks post-insertion.
Lateral view of definitive restorations. Note the adequate volume and support of the soft tissue.
Frontal view of the final smile of the patient.
Radiograph of the definitive restorations.

A step-by step-technique on how to fabricate a personalized impression coping was described to optimize the transfer of the peri-implant soft tissue architecture to the laboratory.

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.


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Comments

Commenter's Profile Image Rasha K.
December 10th, 2020
very nice! Thanks for sharing!
Commenter's Profile Image Ricardo M.
December 10th, 2020
Thanks so much Rasha, I am glad you enjoyed it !