Emergence profile done/ new dentistry technology


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  • jpd vol 62 pages 4-10
  • jpd vol 62 pages 4-10
  • Fig 12 vol 62 jpd
  • Text in the following slide.
  • Fig 13 A vol 62
  • Emergence profiles in natural tooth contour. Part I: Photographic observations: Burney M. Croll; JPD vol 62 1989
  • Emergence profiles in natural tooth contour. Part II: Clinical considerations: Burney M. Croll; JPD vol 62 1989
  • current controversies in axial contour design: JPD 1980 vol 44 pg 536
  • Emergence profile done/ new dentistry technology

    1. 1. Emergence profile INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. Definition by GPT-8 Thecontour of atooth or restoration, such asacrown on anatural tooth or dental implant abutment, asit relatesto the adjacent tissues. www.indiandentalacademy.com
    3. 3. What is emergence profile??? That portion of theaxial tooth contour extending from thebaseof thegingival sulcuspast thefreemargin of thegingiva (FMG) into theoral environment. www.indiandentalacademy.com
    4. 4. What does the term mean???  Theterm emergenceprofilerefersto the cervical outlineof thetooth or restoration as it emerges(exits) theperiodontium. Also called the “egression silhouette” (Rufenacht) www.indiandentalacademy.com
    5. 5. Theemergenceprofileof atooth refersto the angleat which thetooth emergesfrom the gums. Thismust mimic thesilhouetteof the natural tooth, in theonethird of thetooth closest to thegums, when viewed from both thefacial and lateral views. www.indiandentalacademy.com
    6. 6.  A proper emergenceprofilewill help avoid swelling and inflammation of soft tissueand conversely will prevent theunsightly dark spacesin theareanear thegumsand between theteeth.  Theemergenceprofilemust reproduce, in ceramic, theidealized, natural eruption of enamel from healthy gums. www.indiandentalacademy.com
    7. 7.  Thisisan issuewith all the“no-prep veneers”. In most situationsthiswill lead to excessive emergenceprofile(not to mention bulkier- looking teeth) and exactly thekind of gum situationsweshould try to avoid.  Theideal situation for no-prep veneersis wheretheenamel hasbeen worn down to wherethethicknessit would taketo restorethe tooth to anormal emergenceprofileisthe thicknessyou would maketheveneers. www.indiandentalacademy.com
    8. 8. Theemergenceprofileoften extends buccally and lingually to theheight of contour of thecrown of atooth. Fig 1 page4 vol 62 Emergenceprofileof maxillary first premolar, mesial view. www.indiandentalacademy.com
    9. 9. Interproximally, theemergenceprofileextends from thebaseof thegingival sulcusat the cementoenamel junction (CEJ) to thecontact area. Emergenceprofileof maxillary first premolar, buccal view. www.indiandentalacademy.com
    10. 10. Why are the emergence profiles fundamental?  Thesesurfacescan becolonized by the microorganismsthat causeperiodontitis and gingival inflammation.  Accessto thisportion of thenatural or restored tooth surfaceisessential for meticuloushygieneprocedures. www.indiandentalacademy.com
    11. 11. Why are the emergence profiles fundamental?...contd…  Cleanlinessof tooth surfacesin contact with gingival, sulcular, and marginal tissuesisthe key to theprevention of theinflammation preceeding periodontal disease.  Placing therestorativemarginsin theseareas can alter thebiologic relationship between teeth and theperiodontium. www.indiandentalacademy.com
    12. 12. Alterationsin thenatural tooth contour haveexperimentally affected gingival health. www.indiandentalacademy.com
    13. 13. Photographic observations: Sincethebaseof thegingival sulcusis usually located at or slightly coronal to the CEJon young healthy teeth, measurements using thisreferencepoint on thephotographs wereaccomplished with thestraight edgeof theanatomic crownsof extracted teeth. Mostsurfaces measuredhadstraight emergenceprofiles. www.indiandentalacademy.com
    14. 14. Mostsurfaces measuredhadstraight emergenceprofiles… Mandibularfirst premolar, anatomic crown www.indiandentalacademy.com
    15. 15. Thelingual cant of mandibular posterior teeth can bereadily seen, and therelationship of the emergenceprofileto thefreemargin of the gingiva. Mandibular first premolar, sectioned diagnostic casts. www.indiandentalacademy.com
    16. 16. Convexitieswerediscovered palatally in the maxillary incisorsand canines, and lingually on mandibular incisorsviewed mesio distally. Maxillary incisor Mandibularincisor www.indiandentalacademy.com
    17. 17. Palatal convexity in maxillary canine www.indiandentalacademy.com
    18. 18. Concavitieswereregularly observed on the:  distal surfacesof canines  mesial surfacesof maxillary first premolars  mesial surfacesof first molars. www.indiandentalacademy.com
    19. 19. • Maxillary canineand first premolar placed adjacent to each other so that their long axesare parallel and contact areastouching. Theconcaveemergenceprofileof each tooth presentsamirror imageof theother divided by thelinewherethe two photographic printsmeet. www.indiandentalacademy.com
    20. 20. Thelingual surfacesof mandibular posterior teeth havestraight emergenceprofilesfrom theCEJto pointsonehalf to two thirdsof thedistanceto the occlusal surface. Mandibular second premolar, anatomic crown. Mandibular second premolar, sectioned diagnostic cast.www.indiandentalacademy.com
    21. 21. Theemergenceprofileon thebuccal surfaceof themandibular posterior teeth isoneof three straight linescomprising theentirefacial profile. Restorationsmadewith thesefacial contoursarenatural in appearance. Diagram following… www.indiandentalacademy.com
    22. 22. Mandibular first molar, anatomic crown. Intraoral view showing straight emergence profilesin thebuccal vestibuleof mandibular posterior metal ceramic restorationsfollowing patternson contoursinwww.indiandentalacademy.com
    23. 23. Thebuccal and palatal surfacesof maxillary posterior teeth present straight emergence profilesin thegingival third of theanatomic crown. www.indiandentalacademy.com
    24. 24. Thesecond premolar providesan exampleof therelationship of theemergenceprofileof maxillary posterior teeth to thegingival architecture. Crosssection of posterior teeth showing therelationship of clinical crown to gingival architecture. Maxillary molar, mesial surfacewith buccal surfaceto theleft.www.indiandentalacademy.com
    25. 25. Restorationsmadewith convexitiesin thegingival third should beconsidered overcontoured. Over contoured buccal and lingual surfaces. Areaof overcont our www.indiandentalacademy.com
    26. 26. Maxillary first molar, buccal view, concave emergenceprofilebelow mesial contact on right. Interproximally, themesial surfaceemergence profileof maxillary first molarsisconcavebelow thecontact area. www.indiandentalacademy.com
    27. 27. Maxillary canineasan example: Thebuccal profileisseen to consist of 3 straight parts, with theemergenceprofile labeled 1. 4 3 2 1 www.indiandentalacademy.com
    28. 28.  Maxillary canine, anatomic crown. Maxillary canine, sectioned diagnostic casts. Maxillary canine, gingival A B C 41 2 3 www.indiandentalacademy.com
    29. 29.  A comparison of figuresA, B and C indicatesthat most of thebuccal surfaceemergenceprofileof the anatomic crown may besubmerged below thefree marginal gingiva, extending only 1 mm into theoral cavity.  In addition, theconvexity on thelingual surface labeled 4 may also besubmerged below thefree marginal gingivapalatally. www.indiandentalacademy.com
    30. 30. Reviewing thebuccal vestibuleclinically, the emergenceprofilesof thenatural canineand theposterior teeth can often beseen extending to apoint onethird to onehalf of theheight of theclinical crown. Diagram following… www.indiandentalacademy.com
    31. 31. Buccal vestibular view of naturally occuring emergence profiles. Buccal vestibular view of completed metal ceramic maxillary restorationswith straight emergenceprofiles following naturally occurring buccal surfacecontour pattern.www.indiandentalacademy.com
    32. 32. Radiographsareuseful to visualizethe interproximal emergenceprofilesof onetooth asit relatesto adjacent teeth and the emergenceprofileof completed restorations. www.indiandentalacademy.com
    33. 33. Interproximal black triangles (gingival embrasurespaces) can beidentified radiographically, with thebaseformed by the boneand theother sidesformed by the adjacent teeth. www.indiandentalacademy.com
    34. 34. A radiograph of acompleted restoration having retainerswith straight interproximal emergenceprofilescreatesblack triangular spacesand adequateembrasurespacesthat duplicatethemorphology of natural teeth. www.indiandentalacademy.com
    35. 35. A comparison of thetwo demonstratestherelationship of interproximal emergenceprofilesof maxillary incisor teeth seen clinically with aradiograph. Maxillary incisors. . Radiograph of samemaxillary incisors demonstrating straight emergence profileswww.indiandentalacademy.com
    36. 36. Metal ceramic crownswere inserted with long contact areasand straight interproximal emergence profilesfor natural looking restorations, whileclosing theinterproximal gap. 4 maxillary inicisorsafter periodontal surgery prepared for metal ceramic crowns without interproximal papillas. www.indiandentalacademy.com
    37. 37. When thecontact areasarelong occlusogingivally, thenormal emergence profileon thepalatal surfaceprovidesawide open gingival embrasureto support thetissue in itsproper relationship to therestoration and to facilitatehygieneprocedures. www.indiandentalacademy.com
    38. 38. Demonstratesradiographically thecorrect interproximal emergenceprofileof completed anterior metal ceramic restorations. www.indiandentalacademy.com
    39. 39. Burney M. Croll Concluded that with afew exceptions, teeth havestraight emergenceprofilesin thegingival third. www.indiandentalacademy.com
    40. 40.  Selection of thestraight emergenceprofilein designing artificial crownsfor teeth hasshown to improvetheeffectivenessof oral hygienenear the gingival sulcus.  Theaxial profileof teeth can beviewed asaseriesof straight lineswith curved transitions. Reproduction of thesegeometric patternsfacilitatesfabrication of restorationsthat appear natural. www.indiandentalacademy.com
    41. 41. Observationssupporting astraight emergence profileasthenormally occurring tooth morphology approximating thegingival sulcus, based on photographic measurements, areadeparturefrom thetraditional concepts. www.indiandentalacademy.com
    42. 42. Traditional concepts of crown contour: 1) Food deflection theory (Wheeler) • convexitiesto becreated in thecervical third of artificial crowns to deflect food away from thefree gingiva. • Based on thepremisethat food forcefully contactsfreegingivaduring mastication and thiscontact actsasan etiologic agent in gingival disease.www.indiandentalacademy.com
    43. 43. Food deflection theory…contd… Later found Crownsmadewith Wheeler’sconcept Overcontoured Food impaction (causing, rather than preventing gingival inflammation). www.indiandentalacademy.com
    44. 44. Traditional concepts of crown contour…contd… 2) Muscle action theory (Herlandset al and Morris). • Consistent cleaning and molding action by themusclesof thecheeks, lipsand tongue. • Muscleaction can beimpaired when the necessary intimatecontact isprevented by an overcontoured crown or bone. www.indiandentalacademy.com
    45. 45. Muscleaction theory…contd… • Perel studied therelationship between axial tooth contour and marginal periodontium on dogs. • Proceduresproducing undercontoursand overcontourson buccal and lingual crown surfaceswereperformed, • Clinical and microscopic evaluationswere madein respect to thecondition of the marginal periodontium and thecrevicular areas, Heconcluded that: www.indiandentalacademy.com
    46. 46. Perel’s conclusion…contd… 1. Undercontouring of axial surfacesdid not produceany significant changesin healthy gingivae. 2. Overcontouring of axial surfaces, on the other hand, produced inflammatory and hyperplastic changesin themarginal gingivae. Such changeswereseen both clinically aswell ashistologically, after 4 weeks. www.indiandentalacademy.com
    47. 47. Traditional concepts of crown contour…contd… 3) Plaque retention theory Axial contour design based on themuscle action theory. www.indiandentalacademy.com
    48. 48. Traditional concepts of crown contour…contd… 4) Anatomic/Biologic theory • Considered that abiologic contour wasaself protectivecontour to thesupporting tissuesand defended thegingival unit, attachment apparatus, and protected bonefrom traumaand irritation. • Improper contour often induced early breakdown of thesupporting structuresand tooth tissue, resulting in prematurelossof teeth. www.indiandentalacademy.com
    49. 49. Anatomic/ biologic theory…contd… • Stated that thefacial and lingual convexitiesform the height of contour of tooth crowns, which are located at thegingival third of each tooth and are approximately one-half millimeter wider than the adjoining CEJ. • Theexception to thisruleison thelingual surface of thelower molarsand second premolars. There, theconvexitiesmeasureapproximately one millimeter and arelocated halfway between on the occlusal planeand thegingival margin. www.indiandentalacademy.com
    50. 50. Traditional concepts of crown contour…contd… 5) Theory of access fororal hygiene • Based on theconcept that plaqueistheprime etiologic factor in cariesand gingivitis. • Crown contour should facilitateand not hinder plaqueremoval. www.indiandentalacademy.com
    51. 51. Theory of accessfor oral hygiene… contd… The4 guidelinesto contouring crownswith emphasison accessfor oral hygieneare: 1) Flat (and not fat) buccal contours. 2) Open embrasures. 3) Location of contact areas. 4) Fluted or barreled out furcations. www.indiandentalacademy.com
    52. 52. Theory of access for oral hygiene…contd… 1. Buccal and lingual contours- flat, not fat ! • Plaqueretention on thebuccal and lingual surfaces occursprimarily on theinfrabulgeof thetooth. • Reduction or elimination of thisinfrabulge  reduce plaqueretention. • www.indiandentalacademy.com
    53. 53. Theory of access for oral hygiene…contd… 2. Open embrasures: To allow easy accessto theinterproximal area for plaquecontrol. www.indiandentalacademy.com
    54. 54. Theory of access for oral hygiene…contd… 3. Location of contact areas: Contactsshould behigh( incisal third ) and buccal to thecentral fossa( except between thefirst and second molars). Thiscreatesalargelingual embrasurefor optimum health of thelingual papilla. www.indiandentalacademy.com
    55. 55. Theory of access for oral hygiene…3. Location of contact areas: contd… Broad B-L contacts Oversized “col” Non-keratinized area Moresusceptibleto plaque www.indiandentalacademy.com
    56. 56. Theory of access for oral hygiene…contd... 4. Furcationsshould be“fluted” of “barreled out”. Thefinal restoration should not follow theanatomy of the original clinical crown, but should bean extension of the contoursof theperiodontally exposed roots. Triangular region created by therootsand thecervical bulgeiseliminated www.indiandentalacademy.com
    57. 57. • Thecurved profileconcept, although unsupported by photographic evidence, has been classically taught to dental studentsand laboratory techniciansby using linedrawings in technical manualsand atlases. • Thecurved transition of axial tooth contour at theheight of contour isnot alwayslocated at thegingival onethird. www.indiandentalacademy.com
    58. 58. • Interpreting emergenceprofilesasgeometric shapescan provideguidelinesfor oral hygiene, restoration design, and tooth preparation. • A straight lineand acurvemeet only at one point, thetangent. (fig 1 A, vol 63) Conversely, astraight lineand aflat emergenceprofilecan beadapted to one another. www.indiandentalacademy.com
    59. 59. Straight oral hygieneapplianceand straight- curved emergenceprofile. Thecurveand straight linemeet only at tangent. www.indiandentalacademy.com
    60. 60.  Theemergenceprofileaffectsthe convenienceand effectivenessof oral hygieneproceduresdesigned to remove bacterial plaquefrom natural and restored tooth surfaces.  Toothbrush bristlesand tooth picksused in conjunction with handlessuch asPerio-aid devicearestraight in profile. www.indiandentalacademy.com
    61. 61. Convenient adaptation of oral hygieneappliance and emergenceprofileof canine. Notethe relationship of thisangleto theemergenceprofile of premolarsposterior to thecaninel www.indiandentalacademy.com
    62. 62.  Restorationsdesigned and placed with straight emergenceprofilesin thegingival one-third providethepatientswith ashape that isaccessibleand facilitatesoral hygiene.  Thissamerationaleisapplicablein the convex tissue-facing surfaceof themodified ridgelap, recommended by Stein, with optimal contact of thedental floss, improving oral hygiene. www.indiandentalacademy.com
    63. 63.  A straight emergenceprofilewill enable effectivereaching to thedepth of thesulcus in closecontact with thesurfaceof the restoration.  Thisisespecially desirableon thesurfaceof thetooth beyond thecavosurfacemargin, to facilitateremoval of theaccumulated microbial plaque. www.indiandentalacademy.com
    64. 64.  If theemergenceprofileof therestoration is convex in thegingival one-third, it is possible, but inconvenient, to removethe bacterial plaqueon thetooth surface contacting thegingival sulcusbelow thepoint of tangency. www.indiandentalacademy.com
    65. 65. Thelingual surfacesof mandibular incisors providean examplewhereaconvex emergence profilein thegingival third iscommon. Lingual convexity below thegingival tissue. Convexity abovethegingival tissuew thetooth extruded and gingival reces creating aniche, difficult to keep clea www.indiandentalacademy.com
    66. 66. Thecalculusand bacterial plaqueaccumulated on the surfacebelow thelingually convex emergenceprofileare evident becauseit isinconvenient for thepatient to maintain. www.indiandentalacademy.com
    67. 67.  A modification of thenatural tooth can create asurfacethat ismoreeasily maintained by thepatient.  Specifically, thelingual surfaceof mandibular incisorsmay berestored with a straight emergenceprofile. www.indiandentalacademy.com
    68. 68.  If thedentist choosesto extend thecontact areabetween anterior teeth from theincisal embrasureto alevel of thegingival papilla for esthetics, thelingual embrasuremust be wideenough for accessto thegingival tissue under thecontact areafrom thelingual surface.  Diagram following… www.indiandentalacademy.com
    69. 69. Straight emergence profileselected for lingual surfaceof mandibular anterior restoration to facilitate oral hygiene. Completed restorationswith straight gingival emergence profileslingually and open embrasureform below contact areato facilitateoral hygiene from lingual surface. www.indiandentalacademy.com
    70. 70. When viewed from thefacial surface, themandibular incisorshavestraight interproximal emergenceprofiles that begin at theend of along contact areaand extend to theCEJ Relationship of natural anterior teeth-contact areasand gingival tissue. www.indiandentalacademy.com
    71. 71. If restorationsfollow thispattern, they can beesthetic and allow convenient interproximal threading of dental floss. Mandibular anterior teeth with long contact areaand straight emergenceprofile. Mandibular anterior teeth with long contact areaand straight emergence profileon pontic of mandibular lateral incisor.www.indiandentalacademy.com
    72. 72. • Sectioned diagnostic castsreveal aflat facial emergenceprofileof mandibular anterior teeth extending to apoint midway on the facial surfacewhen viewed from theinter proximal aspect. • Diagram following.. www.indiandentalacademy.com
    73. 73. Mandibular canine anatomic crown with gingival overlay. Mandibular canine, sectioned diagnostic cast. Mandibular incisor, sectioned diagnostic cast. www.indiandentalacademy.com
    74. 74. Similar to themaxillary canine, themandibular caninehasaconcavity below thecontact areaon itsdistal surface. www.indiandentalacademy.com
    75. 75.  Tooth preparationsmust beperceptively designed to accommodatedimensional requirementsof restorativematerialswithin thelimitsof theemergenceprofile.  Depth cut” controlled shoulder preparations with ahollow-ground bevel arean approach that meetstheserequirements. www.indiandentalacademy.com
    76. 76. “Theemergenceanglemadeby theemergence profileand thelong axisof thetooth is+15 degrees. www.indiandentalacademy.com
    77. 77. On thebasisof mathematical axioms, Kuwata concluded that if thepath of insertion was parallel to thelong axisof thetooth, all metal ceramic restorationswith cavosurfacebevel angleslessthan 35 degreeswith thepath of insertion should havemetal collarsto prevent over contouring and opaqueexposure. www.indiandentalacademy.com
    78. 78. Laboratory applications If adequatespacehasbeen created for the restorativematerialsduring tooth preparation, retainersof fixed partial denturescan be madewith suitableemergenceprofiles. www.indiandentalacademy.com
    79. 79. Several waxing instrumentshaveaflat surfaceto createaflat profilein themarginal areaof thewax pattern. www.indiandentalacademy.com
    80. 80. Theconvex sideof thewaxing instrumentscan develop concavecontoursin thewax pattern such asthedistal surfacesof maxillary caninesand mesial surfacesof the premolars. www.indiandentalacademy.com
    81. 81.  Mounted grinding wheelsand sandpaper diskshaveflat cutting profilesthat can machinestraight emergenceprofilesand finish restorationsduring fabrication. www.indiandentalacademy.com
    82. 82.  Clinically, thefacial and lingual surfacesof therestorationscan beeasily evaluated for straight emergenceprofilewith aperiodontal probe. www.indiandentalacademy.com
    83. 83. Restorations with suitable facial emergence profiles. www.indiandentalacademy.com
    84. 84. Interproximally, radiographsprovidethebest pictureto establish that thedesired emergenceprofileand adaptation between therestoration and root havebeen accomplished. www.indiandentalacademy.com
    85. 85.  Theoverall axial profileof many dental formsareviewed asaseriesof straight lines with curved transitions.  Reproduction of thesegeometric patterns createsrestorationsthat appear natural. www.indiandentalacademy.com
    86. 86. Recording the emergence profile after tooth preparations for fixed partial dentures. www.indiandentalacademy.com
    87. 87. Soft Tissue TransferModels: The Patient-Dentist- Laboratory Connection  Sebastian Saba, DDS, Cert. Prostho. PhD (Canadian Dental Association) Thedental technician must havean accurate impression of gingival contour, in order to apply porcelain correctly to ametal-ceramic restoration. Thisarticledescribesatechniquefor making an accuratemodel of thesoft tissuesaround a restoration. Thetechniqueinvolvestaking atransfer impression and making asoft tissuemodel. www.indiandentalacademy.com
    88. 88.  Frequently, thelaboratory must interpret the necessary spacefor themetal substructure from trimmed diemodelswhich havelost their original gingival contours.  Often, theresult isassociated with incorrect emergenceprofilesand bulky designsin the metal substructure. www.indiandentalacademy.com
    89. 89. Bulky metal substructurefor anterior maxillary porcelain fused to metal bridge www.indiandentalacademy.com
    90. 90.  Thisisdueto thelossof referencegingival architectureduring dietrimming and separation procedures.  Theframework can still berelated to the gingival architecturewith theuseof soft tissuetransfer models. www.indiandentalacademy.com
    91. 91.  Thesemodelshavegingival maskswhich duplicatethe gingival architectureof theinvolved abutments. Uses: 1) allow thelab technician to seetheexisting gingival architecturesurrounding theinvolved abutmentsand makecorrectionsin themetal substructureto allow for proper emergenceprofileand contour. 2) providethekey to proper ceramic application. It is unreliableto apply porcelain over theedentulousridge and interproximal areaswithout adefinitivesoft tissue model that will reflect thegingival architecturethat must berespected. www.indiandentalacademy.com
    92. 92. Recording Technique   Themetal substructureisseated intraorally and atransfer impression madeusing:- dual wash (light/medium body) technique: - Permadynelight body impression material (ESPE America, Norristown, Pa.) injected around the seated framework andwww.indiandentalacademy.com
    93. 93. Transfer impression incorporating porcelain fused to metal substructure. www.indiandentalacademy.com
    94. 94. Theobjectiveisto capturethegingival contour around theabutmentsand crest ridge. After theimpression hasbeen made, theinside of each abutment retainer isslightly lubricated with athin layer of Vaseline. www.indiandentalacademy.com
    95. 95.  GC Pattern Resin (GC America, Chicago, Ill.) is painted insideeach retainer.  GC Pattern Resin isused to register thelocation of theabutmentswithin thesoft tissuemodel. The dimensional stability of thisresin upon setting, allows for avery accuraterepresentation of theposition of theabutments. www.indiandentalacademy.com
    96. 96.  Thegingival mask isthen madeby mixing Coe-Soft relinematerial (GC America, Chicago, Ill.) into adisposablesyringeand injecting it around thebridgeand themodel ispoured with diestone. www.indiandentalacademy.com
    97. 97. Soft tissuetransfer model with GC Pattern Resin abutment replicas. www.indiandentalacademy.com
    98. 98. Thesoft tissuetransfer model isthen mounted using theinterocclusal registration and the final metal correction and porcelain application instituted. www.indiandentalacademy.com
    99. 99. Properly contoured porcelain of anterior maxillary bridgework: on the soft tissue transfer model respecting the clinical gingival contour. intraoral view, respecting the clinical gingival contour. www.indiandentalacademy.com
    100. 100. Ovate pontic : A natural look  Helpsavoid alveolar collapse.  Thegoal isto createafinal restoration that makestheimpression of atooth emerging from thegum. www.indiandentalacademy.com
    101. 101. • Theovatepontic isatechniqueused to createthe illusion that thetooth isgrowing out of thegum. • Theovatepontic : - helpsto createor maintain thepresenceof interdental papilla. - itscontour isan effectivedesign for cleansibility. www.indiandentalacademy.com
    102. 102. • Theinterproximal tissueshould bepreserved after the removal of atooth. It ishighly desirableto avoid alveolar bonecollapseisin restorativedentistry. • It isimportant to preservethesocket size, shape, and thespaceof thegingival tissuein order to preservethe tissueheight. • When atooth isextracted therecession of the interproximal papillaand thecollapseof thebuccal bonemust beprevented and thismeansthat the extracted socket must bepreserved in thesameshape and location. www.indiandentalacademy.com
    103. 103.  It ishighly important to preservethepapilla during theextraction procedureand to fill the extraction site with the provisional pontic as soon as possible.  Theform of theteeth isnot theonly important matter to takeinto account for aniceoutcome, thecontrol of thegingival contoursisjust as important. Theovatepontic eliminates“black triangle” spaces. www.indiandentalacademy.com
    104. 104.  If atooth isextracted, thelossof support to thepapillawill result in aslumping of thepapillary tissuesimmediately. Within 30-60 minutesthat papillawill haveslumped to thepoint of no return. Theworst thing that can happen, isfor thepatient to biteon the gauzeimmediately after extraction, forcing thepapilladown into thesocket site. Remember, that supporting thepapillaisof utmost importance.  Meticulouscareduring surgery so asnot to disturb the interproximal crestal bone, damagethebuccal or lingual plateof boneor thesoft tissueiscrucial to theformation of anatural looking ovatepontic site. www.indiandentalacademy.com
    105. 105. • By creating apreoperativetemporary bridge for thesocket areawith an ovatepontic design, thepapillaewill besupported during the healing phasepostoperatively. www.indiandentalacademy.com
    106. 106. • In thecaseof theanterior tooth, which has been missing for sometime, generally there will bealossof ridgesupport creating a deficiency or depression in theridgeoverlying themissing root. • Thiswill result in apontic that lookslikeit is hanging from thin air and avery un-natural appearance www.indiandentalacademy.com
    107. 107. Illustration showing pontic hanging from thin air when overlying theedentulousresorbed ridge. www.indiandentalacademy.com
    108. 108. It must benoted at thispoint that thepapillae will havebeen lost. Thereisno way to regenerateapapilla, however by building up theridgewith soft tissue, and then sinking a round diamond into thesoft tissuebuildup, a simulated papillacan becreated. www.indiandentalacademy.com
    109. 109. A small round depression in thegingival tissuealong theridgeiscreated, allowing thepontic or implant to beembedded within the"crater" so asto appear to be emerging from theridgeaswould be seen in anatural emergenceprofile. www.indiandentalacademy.com
    110. 110. Preparation of ovatepontic sitewill createillusion of papillaeinterproximally www.indiandentalacademy.com
    111. 111. • Ridgeaugmentation can beachieved in variousways: bonegrafting, and connective tissuegraftsarethemost common. • Oncetheridgeaugmentation and ovate pontic sitehasbeen developed and supported during healing with atemporary bridge, the final bridgeor implant can befabricated. www.indiandentalacademy.com
    112. 112. Cutting aflap and inserting asection of harvested connectivetissueto build up theridge. www.indiandentalacademy.com
    113. 113. Augmented Ridgeafter healing to level wherepapillae will finish.   www.indiandentalacademy.com
    114. 114. Ovatepontic appearsto benaturally emerging from ridge. www.indiandentalacademy.com
    115. 115. Thedesign of thissupporting bridgemust include: • a3mm projection into thesocket sitefrom gingival crest to thefloor of theovatecrater, • avery smooth and highly polished gingival surfaceto thepontic, • 4.5 mm or moreof contact point spaceto interproximal crestal bonewith widecervical embrasuresto allow for swelling. www.indiandentalacademy.com
    116. 116.  In clinical situationswherethereisablack hole, carefully measurethecrestal boneto contact height. Makesurethereistheideal 4.5mm measurement and that theemergenceprofilefollowsbiological principles.  Leavethecasein provisional restorationsfor 3-8 monthsand allow thepapillato grow back before finishing thecase. Completing thecaseprematurely will not allow enough timefor thepapillato regrow and overbuilding will berequired to eliminatethe black hole www.indiandentalacademy.com
    117. 117. The ovate pontic must be sunk 3mm from the height of the gingival crest. www.indiandentalacademy.com
    118. 118. Theremust beat lease2mm of overlying attached gingival tissue from thebaseof theovatepontic siteto theunderlying bone. www.indiandentalacademy.com
    119. 119. Temporary bridgemust bemadeto form theovate pontic site. Embrasuresmust allow for 4.5mm from contact to crestal bone. www.indiandentalacademy.com
    120. 120. Case history • A 30-year-old healthy femalecomplained about thecross-biterelationship of tooth 12. • Thepatient did not want to go through orthodontic treatment and refused implants. Shewaslooking for aquick way to correct theappearanceof her tooth. www.indiandentalacademy.com
    121. 121. Pretreatment, right lateral view Pretreatment, cross- bite upper right lateral incisor. o complained about the cross-bite relationship of tooth 7. The patient did not want to go through orthodontic treatment and refused implants. She was looking for a quick way to correc www.indiandentalacademy.com
    122. 122. • Alginateimpressionsweremadeto fabricate study models. • Thestudy modelsweresent to thelaboratory for fabrication of thetemporary bridge. • A diagnostic wax-up wasmade. Pictures weretaken. Teeth 13 and 11 wereprepared for bridgeabutmentsand Periapical radiographstaken.www.indiandentalacademy.com
    123. 123. Technique A critical factor isadelicate/ atraumatic extraction of thetooth for bonepreservation. (do not break the labial plateof bone). Atraumatic extraction of tooth 12. Socket site is intact www.indiandentalacademy.com
    124. 124. Thehard and soft tissuesheightswerein acceptablelevels. Bonegrafting and connectivetissuebuild-up wasunnecessary. www.indiandentalacademy.com
    125. 125. • Temporary bridgeresin wasadded to the undersideof thepontic, and reseated so that theresin flowsinto thesocket. • Thebridgewasrelined, removed and the pontic shaped and highly polished. • Then it wascemented into place. www.indiandentalacademy.com
    126. 126. Thetemporary bridgecemented in place after Temporary bridge Sculpting the ovate pontic www.indiandentalacademy.com
    127. 127. A football shaped diamond bur is used to contour the socket site. Site preparation www.indiandentalacademy.com
    128. 128. • Theouter edgesof thecrater areraised 3mm from thefloor of thecrater. Theseouter raised edgesrepresent thepapillaheight and the interproximal col, which surroundsthenatural tooth. • Theshapeof thecrater hasbeen best described asthelarger rounded end of an egg. Remembering biological principles, theremust beat least 2mm of gingival tissuebetween the bottom of thecrater and theunderlying alveolarwww.indiandentalacademy.com
    129. 129. Theprovisional pontic wasconstructed so that the“egg” portion issubmerged into the extraction siteby about 2 to 3 mm. The high polished “egg” portion. www.indiandentalacademy.com
    130. 130. • Thepatient wasinstructed to return in 48 hoursfor removal of thetemporary and evaluation of theextraction socket for proper healing. • After evaluation thetemporary wasre- cemented www.indiandentalacademy.com
    131. 131.  After two weeksthesocket wasrevaluated and thegingival contour wassculpted with electrosurgery. Before gingivoplasty After remodelling www.indiandentalacademy.com
    132. 132. • A seriesof temporary bridgeswasnecessary to manipulatethesoft tissuesto recreate ovatepontic receptor sitesand natural- looking interdental papillae. • After six weeksaslight inflammatory reaction wasobserved in thesoft tissues. www.indiandentalacademy.com
    133. 133. Thedelayed condition isseen to havecaused a slight inflammatory reaction in thesoft tissues. www.indiandentalacademy.com
    134. 134. With each new temporary bridge, theaestheticswas improved and thesoft tissuescompressed to help form thepapillae. The tissue has adapted to the temporary ovate pontic. www.indiandentalacademy.com
    135. 135. Maturation of the pontic site      • Approximately four monthsafter theextraction and four provisional bridgeslater, thesoft tissuesmaturation. • A further increasein thebuccal contraction wasseen, giving asignificant increasein the tooth length whilethepapillaeclosed the interproximal spacesalmost completely. www.indiandentalacademy.com
    136. 136. Oncethefinal work isin place, thescalloped gingival architecturewasseen to bepreserved and harmony wassatisfactory Thesoft issueshavechangesdramatically, showing well-rounded ovatepontic receptor sitesand papillaeformation. www.indiandentalacademy.com
    137. 137. Final impression and cementation • Thefinal impression may betaken threeto four monthsafter extraction, dueto the variability in thehealing processfor each patient. • In thiscasethefinal impression for thefinal restoration wastaken four monthsafter the extraction. • A dual-cureresin cement wasselected. The cementation of themetal-freebridgewasbased on manufacturing recommendationswww.indiandentalacademy.com
    138. 138. Theall-ceramic restorationsareshown bounded in place. Thescalloped gingival architecture, although moreapical in position, appeared to bepreserved and demonstrated satisfactory harmony. www.indiandentalacademy.com
    139. 139. • Thepatient wasinstructed to clean this specific areawith super floss, so asto prevent any possibleinflammatory reaction. • Also, theuseof awaterpik system using low pressure, aiming thewater stream at theteeth at a90-degreeangle, not at thegum tissue, wasadvocated. • Theconvex shapeof thepontic allowsproper cleansing of theedentulousarea. www.indiandentalacademy.com
    140. 140. Pre-treatment. Post-treatment. www.indiandentalacademy.com
    141. 141. Development of implant soft tissue emergence profile www.indiandentalacademy.com
    142. 142. Correction of residual ridgedefects( both hard and soft tissues): • Sub-epithelial connectivetissuegrafts • Socket preservation technique(bonegraft placed into thesocket directly after the extraction). • Full thicknesssoft tissuegrafts. • Immediatepontic technique. www.indiandentalacademy.com
    143. 143. Most healing abutmentsand impression copings arecylindrical in shapeand do not mimic thecontoursof the natural teeth. Theuseof such componentsto makethefinal impression resultsin amaster cast in which thesoft tissue configuration around theimplant platform iscircular. www.indiandentalacademy.com
    144. 144. TheLaboratory technician isleft to either fabricatea prosthesiswith acylindrical emergenceprofileor removethe soft tissueportion of themaster cast and hypothetically design theemergenceprofile. Therefore, any soft tissue sculpting developed clinically by theprovisional restoration islost. www.indiandentalacademy.com
    145. 145. Custom-guided soft tissuecontouring is achieved with theaid of aprovisional crown, which isadjusted and contoured chairsideto thedesired emergenceprofile. A period of 2 monthsisallotted to allow the peri-implant soft tissueto remodel around theprovisional restoration withwww.indiandentalacademy.com
    146. 146. Pro visio nal cro wn fabricated with ideal co nto ur o n a cast generated fo llo wing an impressio n at the implant levelwith a ro und impressio n co ping. www.indiandentalacademy.com
    147. 147. At thistime, an emergenceprofileimpression is made, with theprovisional crown in place, using polyvinylsiloxane. Thetemporary cylinder issubsequently dismantled and connected to theappropriateimplant laboratory analog. www.indiandentalacademy.com
    148. 148. Interproximal view of aprovisional crown connected to a laboratory analog. Buccal view of aprovisional crown connected to alaboratory analog. Notethesmooth transition from around implant to theemergenceprofileof the crown. www.indiandentalacademy.com
    149. 149. Theprovisional crown isplaced on the temporary cylinder, and thewholeentity iscarefully inserted in the emergence profileimpression. www.indiandentalacademy.com
    150. 150. Theprovisional crown connected to the laboratory analog inserted in theemergenceprofile impression prior to pouring with soft tissuematerial. www.indiandentalacademy.com
    151. 151. Theimpression isthen poured with soft tissue material (Gingitech, Williamsand Siliconesystem, Ivoclar North AmericaInc., Amherst, NY, USA; Gi-Mask, Coltene, Whaledent Inc., CuyahogaFalls, OH, USA). www.indiandentalacademy.com
    152. 152. The resulting cast is the emergence profile cast in which the implant laboratory analog is embedded and around which the peri-implant soft tissue is an exact replication of the intraoral soft tissuetopography. www.indiandentalacademy.com
    153. 153. Emergenceprofilecast immediately after recovery from theemergenceprofile impression. Theprovisional crown isstill embedded in theemergence profilecast. Occlusal view of the emergenceprofile cast after removal of the provisional crown. www.indiandentalacademy.com
    154. 154. At thisstage, thelaboratory technician proceeds with the wax-up of acustomized abutment directly on theemergence profilecast, intimately following thesoft tissue Contours. www.indiandentalacademy.com
    155. 155. Buccal view of acustom abutment after wax up using theemergenceprofilecast asaguidefor the emergenceprofile A custom abutment after wax up using the emergence profilecast asaguidefor theemergenceprofile. www.indiandentalacademy.com
    156. 156. Whilefabricating themetal coping of thefinal crown (porcelain fused to metal), thetechnician relies on theemergenceprofilecast for thewax-up and porcelain buildup of thecervical third of therestoration. Theprosthesisisthen finalized. www.indiandentalacademy.com
    157. 157. Buccal view of thecast custom abutment inserted in the emergence profilecast. Buccal view of thecasting placed over thecast custom abutment inserted in the emergence profilecast. Finished crown placed on the emergence profilecast. Buccal view of aporcelain-fused-to- metal custom abutment inserted in thewww.indiandentalacademy.com
    158. 158. Emergenceprofilecast immediately after recovery from theemergenceprofile impression. Theprovisional crown is still embedded in theemergence profilecast. Buccal view of theemergenceprofile cast after removal of theprovisional crown. Note thescalloped anatomical profileof the gingiva. Intraoral buccal view of tooth #7 after insertion. Fabrication of this crown wasdonewith theaid of an emergence profilecast. www.indiandentalacademy.com
    159. 159. In thetechniquedescribed, thetechnician has two casts: an emergenceprofilecast and amaster cast. www.indiandentalacademy.com
    160. 160. Theemergenceprofilecast isobtained from an impression of theimplant supported provisional restoration with polyvinylsiloxane, preferably, or an irreversible hydrocolloid and poured with asoft tissuemodel material. www.indiandentalacademy.com
    161. 161. Thiscast replicatesthecontoured soft tissue and records theperi-implant sulcus. Therefore, it isused for thefabrication of the emergence profileof theimplant abutment and thecervical third of thecrown. www.indiandentalacademy.com
    162. 162. Themaster cast isobtained at theimplant level using theimpression coping. Thiscast isused for the fabrication of thedefinitiverestoration in thestandard way. www.indiandentalacademy.com
    163. 163. www.indiandentalacademy.com
    164. 164. Advantages • Accuracy. • Quick chair-sideprocedure  thepatient will not stay for an extended timewithout aprosthesis. • Doesnot requirethefabrication of another provisional restoration. • Doesnot requirecustomizing theimpression coping. • May beused for screw- or cement-retrained prostheses. www.indiandentalacademy.com
    165. 165. Review of literature www.indiandentalacademy.com
    166. 166. Immediate Dental Implant Placement in Sockets Augmented With HTRSynthetic Bone. Implant Dentistry. 13(1):42-48, March 2004. Castellon, Paulino DDS *; Yukna, Raymo nd A. DMD, MS + • Theclinical resultsof thisstudy demonstratethat immediateimplant placement in combination with HTR synthetic bonegrafting of residual socket voidsand crestal deformitiesisapredictableprocedureand providesagood basefor successful prosthetic reconstruction. • Adequategingival contour and favorableemergenceprofilecan beexpected when combining immediateimplant placement and HTR grafting materia www.indiandentalacademy.com
    167. 167. Tarnow DP, Magner AW, Fletcher P. Theeffect of the distancefrom thecontact point to thecrest of boneon thepresenceor absenceof theinterproximal papilla. J Periodontol 1992;63:995-6.   • They concluded that when thedistancefrom thebaseof thecontact point to thecrest of thebonewas3, 4, or 5 mm: papillawas almost present; • when it was6 mm: Papillawaspresent alittle morethan half of thetimeand • when thedistancewas7, 8, 9, or 10 mm: papillawasmissing most of thetimes.www.indiandentalacademy.com
    168. 168. …contd.. • When an ovatepontic isused thedistance between thecrest of theridgeand thecontact point can beabout 7 mm. • Theovatepontic also providesan excellent emergenceprofileand also aidsin the regeneration of theinterdental papilla www.indiandentalacademy.com
    169. 169. Conclusion  Oneof thecritical variablesin thedesign and estheticsof theprosthetic restoration.  Thelocation and emergenceof theprosthetic margin arecrucial to the: - gingival health and maintenanceof oral hygiene. - esthetic objectives. www.indiandentalacademy.com
    170. 170. References • AccurateTransfer of Peri-implant Soft Tissue Emergence Profilefrom theProvisional Crown to the Final Prosthesis Using an EmergenceProfileCast (JEsthet Resto r Dent 1 9: 306– 31 5, 2007 ) • Useof amodified ovatepontic in areasof ridgedefects: areport of two cases ( JEsthet Restor Dent 16: 273-83, 2004)www.indiandentalacademy.com
    171. 171. References…contd.. • The journal of prosthetic dentistry: 1. Emergenceprofilesin natural tooth contour: Part I: Photographic Observations(july 1989, vol 62, 4-10) 2. Emergenceprofilesin natural tooth contour: Part II: Clinical Considerations( april 1990, vol 63, 374-79) 3. Latestagesoft tissuemodification for anatomically correct implant-supported restorations( 1996; 76: 334-8)www.indiandentalacademy.com
    172. 172. Thejournal of prosthetic dentistry..contd… 4. Development of implant soft tissue emergenceprofile: A technique( 1994; 71 : 364-8) 5. Current controversiesin axial contour design ( november 1980; 44 : 536-40). 6. Current theoriesof crown contour, margin placement and pontic design (march 1981; 45: 268-7). 7. Facial and lingual contoursof artificial completecrown restorationsand theirwww.indiandentalacademy.com
    173. 173. Thejournal of prosthetic dentistry… contd… 8. Axial crown contours(june1971, 642- 49) 9. Artificial crown contoursand gingival health ( nov-dec 1962;6: 1146-56). www.indiandentalacademy.com
    174. 174. References…contd.. • Fundamentalsof esthetics: - ClaudeR. Rufenacht ( QuintessencePublishing Co, 1990) • Contemporary Fixed Prosthodontics: Rosensteil, Land and Fujimoto www.indiandentalacademy.com
    175. 175. References…contd.. • Estéticay Cosméticadental.htm • Journal of theCanadian Dental Association: September 2004, Vol. 70, No. 8. www.indiandentalacademy.com
    176. 176. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com