Soft Tissue Control: In the Aesthetic Zone

Preserving the natural appearance of the peri-implant area is one of the main challenges in implant-supportedrehabilitation of the anterior region. A 48-year-old Saudi woman presented to the prosthodontic clinic complaining of theunaesthetic appearance of her maxillary anterior teeth. Clinical examination revealed advanced periodontitis affectingteeth [12,11,21,22]. After consultation with a periodontist, it was decided to extract these teeth and immediately placeimplants in the sockets of teeth [11,22] with the intention of immediate loading. Although implant placement was performed,adequate primary stability was not achieved. Therefore, the treatment plan was modified to include a transitional dentureas a temporary restoration and the fabrication of customized healing abutments to preserve the soft tissue architecture.Three months later, gingivoplasty and a temporary restoration using the dynamic compression method were performedfor soft tissue management. Subsequently, a modified impression coping was used to record the soft tissue contours andimplant positions in the dental arch for fabrication of the definitive prosthesis. An indirect-direct technique was employedto transfer and replicate the cervical contours of the provisional restorations. This technique facilitates the creation of anoptimal emergence profile by controlling the gingival contour around the implant-supported prosthesis. It is a relativelysimple, accurate, and reliable method for precise replication of the soft tissue profile. By eliminating the intraoral use ofresin monomer, the described approach reduces gingival stress and prevents thermal or chemical injury to the tissues.Additionally, by shaping the soft tissue during healing to achieve the desired contour, it minimizes the need for additionalsurgical intervention. Furthermore, a key advantage is the prevention of soft tissue collapse during the impression procedure,thereby ensuring accurate peri-implant soft tissue morphology. This case report describes the dynamic compressiontechnique with provisional restorations in the aesthetic zone, as well as an alternative impression protocol that accuratelyrecords the peri-implant soft tissue contours and emergence profile following provisional restoration placement.