A New Concept In Maintaining The Emergence Profile In Immediate Implant Placement, The Anatomic Harmony Abutment

The article that I'd like to review today is titled, A New Concept In Maintaining The Emergence Profile In Immediate Implant Placement, The Anatomic Harmony Abutment. This is by a Dr. Richard Akin, in Louisiana. It's in the Journal of Oral and Maxillofacial Surgery, 74 pages, 2,385 to 92, published in June of 2016. He starts the discussion off with immediate implants and molar sites and that they have major challenges, including number one, large extraction sites, number two, implant site preparation challenges, number three, crystal socket morphology is different than stock healing abutments and number four, there's a risk of high occlusal forces with immediate provisional placement on an immediate implant, because it's in the posterior. This is an technique article on the fabrication about custom health abutment at the time of implant placement in the posterior maxilla and mandible, essentially in a molar site. Preoperative considerations include good apical bone and approximately two to three millimeters of attached keratinized tissue.

The harmony technique is described and discussed and they discuss extraction of the tooth, not raising a flap, and then removing the remaining PDL remnants with a round surgical burr and then placing the implant according to the manufacturers protocols. They then take a temporary abutment made out of either titanium or out of plastic or PEEK which is a polyaryletherketone–pSRT, Screw removal tool, stripped dental implant abutment screw, stripped abutment screw head,lastic. They acid etch the metal, except for they leave the top two millimeters next to the actual implant fixture head itself. They leave this in its normal polished state. They then place an contour deposit in vivo, in other words in the site with the temporary abutment attached to the implant and like the material. They then remove this from the mouth and they finish it and they place a mark and a groove on the buckle side and then put some blue stain in there and light cure that blue stain so that the restorative dentist can actually reorient that custom healing abutment when it's taken off in the future.

They also suggest a high pressure steam cleaner for blood and debris removal during the fabrication of this custom healing abutment. After fabrication of the custom healing abutment bone grafting material was then packed and place to the level of the existing bone. They recommend and strongly counsel against overfilling because your custom healing abutment will not seat passively. They then say that you can use a heal plug or a collagen plug around the gingival margin for a seal, but I want to just let you know that they say you may or you can and my impression here is that they're not doing this routinely with collagen. Now, as an aside, this is outside of this article, when I make a custom healing abutment in the anterior I don't place any collagen plug around the margin for a seal. This healing abutment supports the gingival contours and maintains the gingival contours or the emergence profile in these molar sites.

There's a nice little summary that was in the article itself and it had six points that I'd like to share with you. Number one, stabilization of the gingival architecture immediately after extraction and implant placement is a solution of this anatomic harmony abutment. In addition, a solution includes providing a custom seal over the surgical site to retain graft particles. Number three, maintains the ideal emergence profile for optimal final restorative contours. Number four, shortens chair time during impression coping seating, potentially obviating reagraphic exposure to verify abutment seating. Number five, decreasing or eliminating laboratory approximation of emergence profile when shaping the gingival mask during fabrication of the definitive restoration, and number six, expediting final abutment delivery by retaining the gingival emergence architecture. There are definitely some distinct advantages of having a custom gingival cuff that matches essentially the emergence profile of the original tooth.

It makes it so much easier for the lab to create an abutment and final restoration that can fill in and emerge like the natural dentation emerged in that site. Something not mentioned in this article but is my opinion is that if done well this may eliminate a lot of food traps that occur because the difficulty that the restorative dentists in the lab have in creating the adequate emergence and therefore filling in deflects, voids, and potential food traps.

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