When approaching a full arch implant supported prosthesis, it is critical to ensure your lab has the best possible gingival topography for the pontic sites. Often, while making impressions or intraoral scanning, it is difficult to capture the gingival topography in detail. The impression may be slightly altered by the time the provisional is removed and the impression copings secured after a radiograph validating that they are seated all the way

This visual essay shows a simple way to communicate and transfer the gingival topography during the impression process to the laboratory via the master cast. You'll then see how to precisely capture any minor variations in the junction between the gingiva and the prosthesis, by injecting auto-polymerizing low shrinkage PMMA material during the try-in appointment.

This then is easily transferred to the laboratory and the technician can add this contour to the intaglio surface and ensure intimate adaption between the pontic and the overlying tissue, creating an aesthetically pleasing result and a hygiene accessible contour.

Techniques to Transferring Pontic Site Gingival Topography to Your Lab

provisional buccal and occlusal view
Fig. 1. Buccal and occlusal view of the preliminary implant supported provisional
provisional frontal and lateral view
Fig. 2. Frontal and lateral view of the preliminary provisional with the developed pontic sites
developed gingival topography buccal and occlusal intraoral view
Fig. 3. Buccal and occlusal intraoral view of developed gingival topography 2 months' post-extraction.
GC pattern resin
Fig. 4. GC pattern resin used as a method to splint the impression copings and to support/copy the developed pontic sites.
milled PMMA implant on master cast
Fig. 5. Frontal and occlusal view of the milled PMMA implant supported prototype on the master cast.
milled PMMA implant supported prototype
Fig. 6. Intaglio view of the milled PMMA implant supported prototype.
milled PMMA implant supported prototype
Fig. 7. Intraoral buccal view of the milled PMMA implant supported prototype.
post-insertion gingival topography with PMMA implant supported provisional
Fig. 8. Buccal and occlusal intraoral view of developed gingival topography 1-month post-insertion of the new PMMA implant supported provisional.
implant supported zirconia prosthesis
Fig. 9. Frontal view of definitive implant supported zirconia prosthesis.
implant supported zirconia prosthesis
Fig. 10. Intaglio view of the definitive implant supported zirconia prosthesis.
implant supported zirconia prosthesis
Fig. 11. Intraoral buccal view of the definitive implant supported zirconia prosthesis, note the missing ceramic to support the pontic areas.
self-curing pattern resin
Fig. 12. Self-curing pattern resin is injected in the junction between the intaglio surface and the soft tissue in order to capture the missing ceramic to support the pontic areas.
self-curing pattern resin
Fig. 13. Frontal view of the Self-curing pattern resin recreating the missing ceramic in those areas, in order for the lab to add porcelain exactly where it's needed.
definitive prosthesis
Fig. 14. Frontal and intaglio view of the definitive prosthesis after the pontic area modification.
maxillary arch
Fig. 15. Frontal and occlusal views of the maxillary arch during the insertion appointment.
maxilla and mandible final result
Fig. 16. Intraoral buccal view of the definitive zirconia implant supported zirconia prosthesis on the maxilla and tooth supported rehabilitation on the mandible.

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


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