Developing an emergence profile prior to impressioning can help with fabricating a restoration with natural contours. This is usually done with a provisional but it can also be done by modifying the healing abutment. What is your preferred technique to develop the emergence profile?
Can you please describe your technic in adding composite material to the healing abutment to the desired contour? Thank you
Thanks for your question. Essentially you want to imagine the anatomical shape of the tooth at the CEJ. I think occlusal views of extraction sockets help to visualize this (some attached below). Measure the depth of tissue from the implant platform. Add composite or acrylic to a temporary engaging abutment cylinder from the finish line of the abutment up until you match the depth of the tissue incrementally increasing in width and emerge with the desired shape. I general, for an incisor it is triangular, a premolar is ovoid, and a molar is rectangular/rhomboid. Personally, it is easiest in a case when placing an immediate implant without a flap. You just have to add enough until you exit the existing socket and you can easily capture the shape. Then it only requires some trimming and polishing of the subgingival portion. I hope this help. I apologize if it isn't clear.
I think drtoast15 was asking if resin or acrylic sticks to Ti healing abutment surface very well?
if the abutment is not completely smooth and has some retentive grooves milled into it is should stick without a problem. If not, can always cut some grooves or sandblast to increase mechanical retention.
Thanks. As for the case in your original post, did you make some release incisions prior to seating the custom healing abutment?
and how smooth does the custom healing abutment has to be?
As smooth as possible- epithelial cells love smooth surfaces
In this case no, but it is a good idea to allow for more contour adaptation of the surrounding tissue
I like your KISS technique. No need to increase inventory but just a simple modification of an HA. Preference: Anterior: modify a pmma or Ti temp abutment with composite regardless of an emergence 1mm supragingival or a crown. Posterior: round stock HA works for me.