Ideal Abutments Often Require “Surgical Placement”

No Blanching                 Blanching                  Ideal  

The vast majority of implant abutments we fabricate are patient-specific, and created with CAD/CAM technology. When designing the emergence profile of the abutments, the doctor has three choices. The first is “no blanching” of the tissue. This abutment will seat without disturbing the sulcus.  A second option, “blanching”, our standard (1mm at the margin), will allow for more natural emergence. The third choice is “ideal,” sometimes called “surgical abutments,” which provide the best esthetic and hygienic result, expanding the emergence profile to that of a natural tooth.  This choice allows us to create crowns that look like teeth, and minimize black-triangles and food-traps. One caveat to this procedure is the amount of tissue displacement. At the seating appointment, the blanching will often necessitate mesial and distal incisions to relieve pressure.

Custom Impression Posts

 Incisions during final seating can be avoided with some preplanning. Impressions can be captured at the time of implant placement, or sometime after, to design custom healing abutments to reshape the sulcus. After the sulcus exhibits the ideal shape  this contour can then be transferred to the lab. A stock implant transfer post will not adequately fill the sulcus, so a customized impression post will be required to communicate the soft tissue contours. A custom impression transfer can be created by injecting flowable composite around the impression post capturing the expanded sulcus dimensions. Once light-cured, the composite is affixed to the impression post; it should be removed and trimmed to eliminate flash prior to taking the fixture-level impression. A work authorization should note the use of this procedure.