Creating an excellent emergence profile: interview with Dr. Pariente
Dr. Pariente, what are the most important things to consider when working to create an excellent emergence profile?
“The emergence profile should be considered as a whole concept: it is the portion of the prosthesis that allows the implant to turn into a natural-looking tooth. It is the border between the surgical and prosthetic worlds. An excellent emergence profile gives a smooth transition from the circular implant platform to the natural shape of the tooth at the gingival level. It should be customized for every restoration.
“To be ideal, it should be considered during the implant planning phase. Key is selecting the right implant, both in terms of connection type and platform diameter as well as implant positioning in all three dimensions.
“Clinical factors to take into consideration are the thickness of the gingiva in the area of implant placement, the size of the horizontal cross section of the future crown at the gingival level, and the position of the future crown relative to the bone.”
How exactly does the choice of implant affect the emergence profile?
Firstly, the discrepancy between the diameter of the implant platform and the cross-section diameter of the future crown at the gingival level needs to be compensated by the abutment.
“The contour of the abutment from the platform to the gingival level is the emergence profile. The angle between the platform of the implant and the wall of the abutment should be as wide as possible to avoid creating a bacteria reservoir.
“In addition, the connection type (external or internal) and the collar of the implant, whether polished or not, have a direct influence on how deep an implant can be placed to preserve the surrounding bone from physiologic resorption while retaining the biologic width.
“Internal connections such as Nobel Biocare’s conical connection, which can be placed under the bone level, allow more flexibility when placing the implant. Smaller platform implants should be placed deeper, leaving more vertical room to compensate the discrepancy in diameter between the horizontal cross section of the future crown at the gingival level and the platform itself.”
Why is it worth investing time and effort in optimizing the emergence profile?
“An optimal emergence profile supports the gingiva around the implant-supported crown. This prevents the formation of proximal or buccal/lingual food traps. It is a prerequisite for the formation of pseudo-papillae in the inter-proximal spaces.
“When the emergence profile is optimal it allows the patient to maintain the required level of hygiene around the implant. Poor emergence profile design has consequences that can ultimately lead to the loss of the implant.”
What are the main challenges that can hinder the creation of an optimal emergence profile?
“The main challenges that prevent a clinician achieving an optimized emergence profile are improper choice of implant diameter and/or improper implant placement depth.
“Another consideration is that, in anterior cases, it is required to create an ideal gingival contour with a provisional crown before taking the impression for the final crown. The main challenge can be accurately transfering the soft tissue contour to the cast.”
Finally, what are the main misconceptions you hear about the emergence profile?
“Because of the popularity of standard abutments that are cheap and easy to use, people often think that it is very complicated or expensive to create abutments with a customized emergence profile. The accessibility of NobelProcera solutions should make customized abutments the standard of care.”