Preserving the Dental Emergence Profile: The Transmucosal Zone – Part 1


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The biological hybrid concept

In this tutorial Dr. Michael Berthold, M.Sc. and MDT Otto Prandtner present a workflow for preserving hard and soft tissue structures.

In the first step of their collaboration, they create a workflow that outlines the clinical and technical steps that will lead to the ideal result. According to this workflow, the diagnosis was made by the practitioners Dr. Reza Saeidi Pour, Dr. Michael Berthold and Otto Prandtner, MDT. The patient-oriented treatment planning and decision making is thus determined in anterior implant dentistry.

  • Ideal surgical planning is always related to the ideal / final prosthetic design (interdisciplinary approach).
  • Surgical interventions should create the frame for the prosthodontist.
  • The restorative healing cap creates a gingival topography that reproduces the rootshape and defines the gingival undulation.

The transmucosal zone is the most sensitive zone in modern implantology.
When success is measured by the preservation of supporting hard and soft tissue rather than the longevity of the crown, the patient is much better served.

From the patient’s point of view, the appearance of the peri-implant soft tissue and the prosthetic substructure are a very important aspect in evaluating a successful implant treatment.

This tutorial shows template-guided immediate implant placement in the esthetic region with appropriate hard and soft tissue management. Furthermore it describes in detail the planning process.
The use of predictable biological techniques for hard and soft tissue reconstruction, coupled with digital planning, are a key aspect of the concept.

The design of the subgingival and transgingival contour is decisive in the fabricated healing cap, which ideally copies the natural root shape and thus ideally supports the emergence profile or, through targeted modification, provides good support for periodontal plastic measures. This results in the three-dimensional implant position, taking into account sufficient primary stability and peri-implant augmentation measures.