Temporary Crown for Implant: How do I Contour this to Prevent Gingival Recession?

Dr. M. asks:
I have just started doing implants. I have a patient who needs a #8 [maxillary right central incisor] extracted and replaced with an implant. I saw him this afternoon. I sent him over to my periodontist who is planning to extract #8 tomorrow and replace it with a NobelBiocare Replace Select tapered implant, regular platform. He is going to put a healing cap on and send the patient over to me to place an abutment and temporary crown. He advised placing a temporary metal abutment cylinder and making a temporary crown over it. How do I contour the buccal of the temporary crown to prevent gingival recession? My periodontist specifically warned me about this, but I am not sure exactly how to shape the buccal contour.

5 thoughts on “Temporary Crown for Implant: How do I Contour this to Prevent Gingival Recession?

  1. Use custom temporary abutments and lab fabricated temporary crowns to develop the correct marginal contours of the tissue.
    To assit your lab in the planning it is important to give them a pre-op model so they can plan to contour the gingiva to mirror image the rise and fall.
    It is critical that the abutment follow the correct anatomical immergence profile and this line is no more than 2mm below the tissue and… the temp crown continues the immergence profile of the t/abutment. The lab componants are usually heat cured to eliminate free monomers and hand polished to have a smooth surface to reduce irritation of the soft tissue.

  2. Dear Dr.M,
    First of all you should preserve the extraction margin and transfer to stone model ferfectly.There is contour abutment some system(Zimmer) but I dont know if Nobel does.İf not after insert the abutment before impression you can add some flow composite around abutment in order to keep the space of the area.than impression…That lab could easely make the temporary immergence profile..good luck..

  3. I use this system and the best way to make the temporary crown is at the chairside using conventional temporary crown material (e.g. Protemp) and making a vacuum-formed splint or even thin mouthguard to get the correct basic tooth contour.The buccal contour(or for that matter palatal and interproximal)at the interface between fixture and cylinder needs to be added free-hand out of the mouth and I find flowable composite to be the best choice.It’s rather like shaping any other temporary crown and can be highly polished using Soflex discs. Having said all that, it’s very time-consuming and I allow 30mins to place a fixture but another 60mins if I have to make a temporary crown.
    The other comments rely on a certain down time using labs. In my experience, most patients want a replacement tooth (especially a central incisor), immediately – not in a weeks’ time!

  4. build the tissue support on the stock abutment using composite,prep margins and reline a temp on top.leave out of occl.good luck.

  5. It is the implant that will prevent gingival recession, If there is bone loss around the implant the tissue will recede, there is about 3mm of healthy gingiva above the bone. Reasonable tissue pressure will not cause bone loss with an implant. A number of implants have proven ability to maintain the bone, and that will maintain the soft tissue. There is lots of research on this.
    Jon

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