Aesthetics for the controlled gingival management

We are working with implantologists that are specialized in gingival management. In order to reach perfect results, the implantologists needs a lot of experience in soft tissue- and bone-management and the laboratory needs a lot of experience in the designing of individual abutments and model-management. Because ill-fitting prosthetics can quickly destroy the work of the implantologists. When it comes to complex, whole-arch restorations, we’re always working with long-term temporaries with reinforced metal for immediate restoration. This way, the gingiva is being perfectly prepared for the implants.

Conscious model-management at the laboratory

This case shows how complex perfect gingiva management can sometimes be. Our long-term temporary has been placed three days after surgery. After that, it took over nine months until the gingiva conditions were good enough so we could start with the dental provisions. Especially the dehiscence at 11 cause a lot of trouble.

Comparison model-management and mouth situation

With our specialized model management, we’re trying to model the gingiva situation on our model the way it should look after the implantation of the dentures in the mouth. This way I’m setting the base on which my technicians are going to create the margins of the crowns. This way, we are preventing crown margins that are too thick. The gingiva has space, fills the interdental space and stays stable. The pictures show the situation right after the placement. Even after the placement of the definite denture, there had to be some optimization at 11.

Specialized model management for single crowns

Single crowns need gingiva management on models, too. We’re not going by the imprint-/model situation, but are designing the desired situation which is loved by the mucous membrane, too. This way, there are no recessions.

Creating the crown design

We are creating the design of the crown beneath the gingival-hem after the concept of Dr. Marius Steigmann on our model and are controlling it in the mouth in order to check the adaption of the gingiva. The abutments are kept very slim during this procedure and the gingiva management is exclusively created by the crown. Depending on gingiva type, implant position and angle, there are also other concepts. Dr. Steigmann created an algorithm especially for this purpose. If you want to learn more about this, you can take a class with Dr. Steigmann. http://www.steigmann-institute.com

Final result

Here you can see how important it is to not go by the imprint and given model situation, but by the desired situation in which the gingiva can still grow. The pictures show the crown right after the placement of the implant and three months later.

Single crown with gingiva gain

This case is especially interesting, because we were able to use the original tooth as template, the gap was very small. We tried to solve this case with a zirconium oxide-abutment and an E-Max-crown. Both failed because there was not enough space. Crown and abutment kept breaking. The final solution was a titanium-abutment and a normal pfm-crown. The gingiva situation was perfect. The patient was wearing a temporary implant until the gingiva was built perfectly. In the end, we even gained 1 mm more gingiva than with the original tooth.