Case 62 | Prosthodontic Award 2015 | Italy
Dr. Gabriele Caruso
A novel approach in prosthetic and transmucosal implant dentistry: the “Vertical Neck®” design
The present case report describes a novel approach in prosthetic and implant dentistry thanks to a new implant design called “Vertical Neck®”, characterized by a transmucosal conical segment without prosthetic shoulder and an Implant-Abutment Interface (Microgap [MG]) located more than 2 mm above the alveolar crest close to the gingival margin.
This approach allows to define a customized, scalloped-designed restorative finishing line combined with an anatomical emergence profile, well defined prosthetic margins location of the clinical crown, with the only Microgap being located within the periimplant gingival sulcus and in a more biocompatible fashion. This step-by-step documentation describes the clinical procedure on a 18-year and 7-months old male patient and in a single tooth edentulous site of the anterior maxilla (21).
Material and Method
The “Vertical Neck®” implant (Biotype Implant System®, Cagliari / Italy) exhibited a cylindrical full-body screw shape design with a tapered apical portion made from commercially-pure grade 4 titanium. The regular neck inner implant diameter with the threaded part was 4.8 mm. The transmucosal conical segment of the “Vertical Neck®” implant had two outer diameters: the apical one measured 4.8 mm, whereas the coronal one was 4.1 mm in diameter. The upper portion of the implant consisted of a 2.5 mm relatively smooth, machined titanium surface in length, with the conical part measuring 1.9 mm in length (‘preabutment’). The rough part of the implant consisted of a sandblasted, large-grit and HCl/H2SO4 dual acid-etched surface with a length of 13 mm and a self-tapping thread design. In addition, the most coronal section was modified with a microgroove texture. In addition, the screw-retained abutment connected to the external hex design of the one-piece soft tissue level implant body design.
In this clinical case we were able to achieve the entire interproximal papilla in both sites, mesial and distal.
Conclusions and clinical implications
The aesthetic of the periimplant gingiva can be enhanced through modification of the edge, shape and depth and the prosthetic restoration’s emergence profile. In order to put this technique in practice, it is necessary to utilize a conical transmucosal implant segment (Vertical Neck, Biotype Implant System) which allows modifications on prosthetic restoration. These modifications imply clinical meaningful effects. Nonetheless, further studies are required to build a link between prosthetic margins and emergence profile, requirements of soft tissue and periimplant gingiva ‘s adaptation.
1. Preoperative photograph with lip retractors.
2. Implant positioning in site 21, vestibular aspect.
3. 3 months post-op.
4. Virtual model: gingiva and abutment.
5. Defining the prosthetic margins on the preabutment and on the abutment.
6. Provisional crown cemented, with a well defined emergence profile on the vertical transmucosal segment.
7. 34 days after provisional crown delivering.
8. Adaptation of the gingiva around the emergence profile of the provisional crown.
9. Definitive crown: note the emergence profile to support and shape the soft tissue.
10. Definitive crown: 30 months after occlusal loading, vestibular aspect. The entire interproximal papillae are achived.
11. Definitive crown: 30 months after occlusal loading, vestibular aspect.
12-13. Periapical radiographs of tooth 21, using parallel technique, control before crown delivering and after 30 months of occlusal loading.