Customized implant impression copings: provisional cast technique

Provisional implant prostheses are recommended for use in the aesthetic zone to develop the optimal soft tissue emergence profile. A randomized controlled clinical trial compared aesthetic outcomes of implant supported crowns with and without the use of provisional crowns. It was found that provisionalization significantly improved the final aesthetic outcome using objective measures for both the peri-implant mucosa and implant-supported crown.¹ Once the clinician is satisfied with the soft tissue aesthetics achieved with the provisional restoration, the definitive impression should be taken with the aim of reproducing the desired soft tissue emergence profile created. Conventional implant impressions are not able to capture the moulded soft tissue because the tissues are at risk of collapse during the impression-taking stage, which can result in an under-contoured definitive restoration. One published technique that aims to prevent soft tissue collapse, involves removal of the provisional prosthesis, placement of the impression coping intra-orally and immediate placement of flowable composite into the peri-implant crevicular space.² While this is likely to be better than a standard impression coping, there is still risk of soft tissue collapse owing to the time taken to remove the crown, seat the impression post, and place the flowable composite. The use of a custom impression coping captures the true soft tissue emergence profile achieved by the provisional restoration. This Technique Tip describes a novel modification to the existing technique.