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special feature

How to optimize the emergence profile


An interview with clinician Dr. Léon Pariente

by Michael Stuart, Nobel Biocare

n According to Dr. Léon Pariente, a leading


clinician based in Paris, France, the emer-
gence profile matters. In this short interview
on the topic, he explains why efforts to op-
timize the emergence profile should begin
at the planning stage.

Nobel Biocare: Dr. Pariente, what are the


most important things to consider in work-
ing to establish an optimal emergence pro-
file?
Dr. Léon Pariente: The emergence profile
should be considered holistically: 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 optimal 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, particu-
larly in selecting a suitable implant, both in
terms of connection type and platform diam-
eter, as well as in determining the implant
positioning in all three dimensions. Clinical
factors to take into consideration are the  Dr. Léon Pariente
thickness of the gingiva in the area of im-
plant placement, the size of the horizontal nection, which can be placed under the The main challenges that prevent a
cross-section of the future crown at the gin- bone level, therefore allow more flexibility clinician achieving an optimized emergence More to explore!
gival level, and the position of the future when placing the implant. Smaller-platform profile are improper choice of implant
crown relative to the bone. implants should be placed deeper, leav- diameter or incorrect implant placement In order to see an ideal
ing more vertical room to compensate for depth. emergence profile in one
How does the choice of implant affect the the discrepancy in diameter between the Furthermore, in anterior cases, an ideal of Dr. Léon Pariente’s
emergence profile? horizontal cross-section of the future crown gingival contour must be created with a pro- case reports, scan the
Firstly, the discrepancy between the di- at the gingival level and the platform it- visional crown before taking the impression following QR code:
ameter of the platform of the implant and self. for the final crown. The main challenge in
the diameter of the cross-section of the fu- this case can be transferring the soft-tissue
ture crown at the gingival level needs to be Why is it worth investing time and effort in contour to the cast accurately.
compensated for by the abutment. The con- optimizing the emergence profile? abutments with a customized emergence
tour of the abutment from the platform to An optimal emergence profile supports Finally, what are the main misconcep- profile. The accessibility of the NobelProcera
the gingival level constitutes the emergence the gingiva around the implant-retained tions about establishing the emergence solution should make customized abutments
profile. The angle between the platform of crown. This prevents the formation of proxi- profile? the standard of care. 7

 PEEK performance: In this case, Dr. Léon Pariente used a PEEK Healing Abutment to shape the soft tissue.  The lateral view after crown placement shows proper support of the soft tissue.

the implant and the wall of the abutment mal or buccolingual food traps and allows Because of the popularity of standard
should be as wide as possible to avoid creat- the patient to maintain the required level of abutments that are cheap and easy to use,
ing a bacteria reservoir. hygiene around the implant. Furthermore, people often think that
In addition, the connection type (exter- it is a prerequisite for the formation of it is very complicated
nal or internal) and the collar of the implant, pseudo-papillae in the interproximal spaces. or expensive to
whether polished or not, have a direct influ- Poor emergence profile design can have con- create
ence on the depth to which an implant can sequences that can ultimately lead to the
be placed to protect the surrounding bone loss of the implant.
from physiological resorption while retain-
ing the biological width. Internal connec- What are the main challenges in establish-
tions such as Nobel Biocare’s conical con- ing an optimal emergence profile?

Nobel Biocare Global Symposium 13


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n The KaVo MASTERsurg LUX Wireless was mable steps.
designed to redefine surgical standards, of-
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vidual needs. provided by the INTRA LUX S600 LED, one
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With an eye toward maximizing comfort,
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from peace of mind, the data documentation Another critical feature is the customiz- ferent bone densities, a substantial difference in delivering maxi-
function supports procedures with real-time able programming to address individual implant systems and mum performance on a daily basis. 7

Treatment planning: Begin with the end in mind


The value of planning for final results before treatment initiation

by Dr. Gary Orentlicher, US ough analysis of bone volume and structure 8 significant alteration of bony anat-
and of tooth and implant orientation. This omy (e.g., trauma, grafting, distrac-
n I have frequently remarked that in the last means more precise evaluations, minimally tion and pathology)
15 years there has not been a greater prac- invasive procedures, more predictable treat- 8 medical problems (e.g., radiation
tice builder for me, as an oral and maxillofa- ment results, shorter appointment times and therapy, bleeding dyscrasias, and
cial surgeon, than my involvement in guided happier patients. orthopedic and psychological prob-
surgery. Using my i-CAT (Imaging Sciences lems).
International), in combination with Nobel- In a presentation I made this spring,
Clinician Software (Nobel Biocare), has made I spoke about what I regard as the indica- In each case, there are four primary
me a better, more accurate dental implant tions for guided surgery. They include steps to a successful guided surgery
surgeon, and most importantly, has greatly workflow:
improved my patients’ case outcomes. It 8 three or more implants in sequence
has changed the way I practice daily in all 8 cases with anatomical and/or structural 8 Step 1: 3-D imaging with a scanning
aspects of patient diagnosis, planning and issues prosthesis or optical scans
surgery. 8 implant position critical to a planned res- 8 Step 2: 3-D treatment planning with
toration planning software
i-CAT and NobelClinician allow for treat- 8 problems related to proximity of adjacent 8 Step 3: Creation of a computer-
ment planning and surgical predictability teeth generated guide, laboratory and sur-
with full 3-D and restorative outcomes in 8 fully edentulous patient cases gery  Dr. Gary Orentlicher
mind. i-CAT’s high-resolution volumetric im- 8 immediate extraction and implant place- 8 Step 4: Knowledge of the appropriate
ages provide complete views for a more thor- ment implant-specific drilling instrumentation.
I have my CBCT scans converted into
In my clinical ex- DICOM data sets and imported into Nobel-
perience, the quality Clinician for treatment planning. I have used
of the products one most implant software on the market and
uses makes a signifi- I feel strongly that NobelClinician is the pre-
cant difference in mier product.
the process and final
treatment result. I For clinicians with an interest in using
look for quality, ease the power of 3-D to create implant treatment
of use and support plans, they will be making an investment in
that helps me prac- their clinical skills and improving their pa-
tice with the great- tients’ experiences and outcomes. This will
est amount of confi- lay the groundwork for increasing treatment
dence. acceptance rates and implant practice
growth. 7
I use the i-CAT
cone beam 3-D unit,
which offers many About the author
valuable features, in-
cluding flexible im- Dr. Gary Orentlicher is Chief of Oral and
aging control. This Maxillofacial Surgery at White Plains Hos-
allows me to custom- pital in White Plains, New York. He is a dip-
ize my scans by min- lomate of the American Board of Oral and
imizing the field of Maxillofacial Surgery, a fellow of the Amer-
view and radiation ican Association of Oral and Maxillofacial
dosage while maxi- Surgeons, and a member of many regional
mizing resolution. and national dental and oral and maxillofa-
With i-CAT, I gain cial surgery organizations. He is a partner
greater control over in the New York Oral, Maxillofacial, and Im-
my workflow and the plant Surgery private practice in Scarsdale,
entire scanning pro- New York.
 Treatment planning software used for fully edentulous patients. cess.

12 Nobel Biocare Global Symposium

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