DENTAL TECHNIQUE

A digital technique for cloning the emergence profile of the

interim to the definitive implant-supported restoration
Yolanda Natali Raico Gallardo, DDS, MS, PhD,a Jorge Noriega, DDS, MS,b
Isabela Rodrigues-Olivio, DDS, MS, PhD,c and Newton Sesma, DDS, MS, PhDd

A successful implant-supported ABSTRACT

restoration in the esthetic zone
The subgingival contour of implant-supported restorations is key to ensuring the long-term health
requires healthy peri-implant of the peri-implant bone and soft tissues. This report describes a step-by-step technique used to
tissues, a well-contoured accurately clone the emergence profile of the interim crown for the definitive implant-supported
emergence profile, and har­ restoration. (J Prosthet Dent xxxx;xxx:xxx-xxx)
mony with adjacent teeth.1–6 A
satisfactory emergence profile can be developed by con­ implant-supported interim restoration in place.
ditioning the soft tissue with an interim restoration.7–11 Before scanning, apply a flowable composite resin
Once an appropriate emergence profile has been estab­ (Filtek; 3M ESPE) to the facial surface of the in­
lished, restoration contours should be accurately trans­ terim crown by following Clavijo et al14 (Fig. 1).
6,10–12
ferred to the definitive restoration. 2. Remove the interim restoration and scan the gin­
The interim restoration needs to be removed to record gival and peri-implant tissues.
the soft tissue. However, the emergence profile tends to 3. Place a scan body (Cares RC Scanbody; Institute
collapse soon after removal, preventing the accurate re­ Straumann AG) and scan immediately (Fig. 2).
cording of the soft tissue architecture and jeopardizing Connect a healing abutment (RC Healing abut­
the esthetics of the definitive restoration.8,12–15 However, ment; Institute Straumann AG) to the implant to
digital scanning can overcome this problem and has ad­ avoid patient discomfort.
vantages that include saving time, improving patient 4. Scan the opposing arch and the occlusal registration.
comfort, and delivering predictable results.8,12,14,16 5. Scan the interim crown, creating a new case for
A digital scanning technique is described to accurately the patient in the software program. Hold the
reproduce the emergence profile of the interim restora­ crown with an abutment holder (Analog holder;
tion in the definitive implant-supported restoration. Institute Straumann AG) or similar device during
scanning (Fig. 3).
6. Export all the mesh files and send them to the
TECHNIQUE dental laboratory technician.
Clinical procedure
Laboratory procedures
1. Once the optimal emergence profile and gingival
margin location have been achieved, scan (TRIOS 1. Import all the scans into a digital design software
3; 3Shape A/S) the maxillary arch with the program (exocad DentalCAD; exocad GmbH) and

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
a
Professor and Director, Laboratorio Digital y Prótesis, Scientific University of the South (UCSUR), Lima, Peru.
b
Professor and Coordinator, Specialty in Periodontics and Implantology, University of Applied Sciences (UPC), Lima, Peru.
c
Private practice, São Paulo, Brazil.
d
Professor, Department of Prosthodontics, University of São Paulo (USP), São Paulo, Brazil.

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Figure 1. Interim implant-supported restoration with flowable
composite resin mark.
Figure 2. Scan body in place to record implant three-dimensional
position.
align the scan body with the compatible pair in the
digital library. Then, superimpose the preoperative
scan on the interim emergence profile file (Fig. 4).
2. Omit the delimitation of the abutment margin line
step. If a personalized abutment bottom is gener­
ated, it must be kept at minimum parameters so as
not to alter the interim crown shape (Fig. 5).
3. Design the definitive restoration by following the
anatomic features of the adjacent tooth and op­
posing arch.
4. Use the tool “adapt to pre-op scan” to copy the
shape of the interim restoration. Thus, the interim
crown emergence profile will be completely cloned
and digitally polished (Fig. 6). Then, export it as a
standard tessellation language (STL) file for sub­
tractive manufacturing.
THE JOURNAL OF PROSTHETIC DENTISTRY
5. Finally, apply the veneering porcelain according to
the surface and characteristics of the adjacent teeth.
Once the color and esthetics have been approved
by the patient, cement it to the abutment (RC
Variobase for crown; Institute Straumann AG).
Screw and tighten the definitive restoration to the
implant (Fig. 7).
DISCUSSION
The present report describes a technique for digitally
transferring the emergence profile of the interim to the
definitive restoration. Accurate transfer is an important
step in obtaining optimal esthetics, function, and a more
predictable outcome for implant-supported restora­
tions.5,7,9,10 The subgingival contour of the definitive
restoration must be a smooth and highly polished zir­
conia surface, without the need for adjustments in the
mouth.3,4 Therefore, a straightforward, rapid, and ac­
curate technique is required to reproduce the emergence
profile established with the interim crown in the defi­
nitive prosthesis. The technique presented requires
minimal time and is a straightforward method of
transferring the emergence profile with a digital work­
flow. An advantage of the present technique is that the
use of irritant material such as acrylic resin is not ne­
cessary to customize the transfer abutment for a con­
ventional impression.1
The replication accuracy of the digital emergence
profile of interim implant-supported restoration was
evaluated in 16 patients.15 Peri-implant soft tissues was
reported to collapse within 20 seconds when the interim
restoration was removed, with a deformation in the cuff-
like submucosal region of 414.7 ± 116.0 µm. Peri-im­
plant soft tissues collapse may cause inaccuracies when
the soft tissue is scanned, as the accuracy of a soft-tissue
scan has been reported to be between 80 and 230 µm.15
Errors associated with gingival collapse may be avoided
if a digital copy is made of the emergence profile.6,8,11–13
The 3D meshes were compared in a metrology
software (GOM Inspect; Zeiss) (Fig. 8) to determine
whether the emergence profile of the interim restoration
was cloned in the definitive restoration. The comparison
showed a volumetric discrepancy under 30 µm. This
value is considered clinically acceptable because the di­
mensions of a healthy cuff in peri-implant soft tissues
Gallardo et al
Month xxxx 3

Figure 3. Scan of interim implant-supported restoration.

have been reported to vary between 3.5 mm on flat

Figure 4. Three-dimensional meshes paired in dental design software program.
surfaces and 5.5 mm on proximal surfaces.2 The 3D
meshes of the definitive versus the interim restoration
have been compared11 and show a total volume dis­
crepancy of 2.4%. The authors concluded that this
technique produced a successful definitive restoration
without any chairside adjustment. The authors are
unaware of a clinical study reporting the accuracy of 3D
superimposition files to create a copy of the interim
restoration. However, the accuracy of merging 3D files
to create a virtual patient has been reported to be be­
tween 0.5 and 1.64 mm for trueness and 0.04 and
0.14 mm for precision.16
Limitations of the technique include the cost of the
intraoral scanner and dental design software program, the

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Figure 7. Definitive implant-supported restoration.

clinician’s knowledge of and experience with the digital

workflow, and careful laboratory work. Clinical studies
should compare the digital versus the conventional
Figure 5. Abutment bottom design with minimum parameters. method of transferring the emergence profile, as well as
the long-term consistency of the clinical outcomes.

A B
Figure 6. Digital design of implant-supported restoration. A, Interim emergence profile cloned. B, Cross section view of all three-dimensional
meshes.

THE JOURNAL OF PROSTHETIC DENTISTRY Gallardo et al

Month xxxx
Figure 8. Color map of three-dimensional mesh comparison between interim and definitive implant-supported restoration.
SUMMARY
Digital workflows produce predictable and accurate
clinical outcomes. The present technique for cloning the
emergence profile of the interim to the definitive im­
plant-supported restoration resulted in good function,
excellent esthetics, and high patient satisfaction.
PATIENT CONSENT
Written informed consent was obtained prior to the
report.
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16. Revilla-León M, Zandinejad A, Nair MK, Barmak AB, Feilzer AJ, Özcan M. Acknowledgments
Accuracy of a patient 3-dimensional virtual representation obtained from The authors thank Mr Wilfredo Chuquisuta and Ms Emily Aguilar for their
the superimposition of facial and intraoral scans guided by extraoral and support in the design and manufacturing process.
intraoral scan body systems. J Prosthet Dent. 2022;128:984–993.
CRediT authorship contribution statement
Corresponding author: Yolanda Natali Raico Gallardo: Conceptualization, Methodology, Writing-
original draft, Visualization. Isabela Rodrigues-Olivio: Writing – original draft.
Prof Yolanda Natali Raico Gallardo
Jorge Noriega: Conceptualization, Resources, Visualization. Newton Sesma:
Innovation Center in 3D Dentistry
Writing – review and editing, Supervision.
Scientific University of the South (UCSUR)
19 Panamericana Sur Road
Villa El Salvador, Lima, 15067 Copyright © 2023 by the Editorial Council of The Journal of Prosthetic Dentistry.
PERU All rights reserved.
Email: yraico@cientifica.edu.pe https://doi.org/10.1016/j.prosdent.2023.10.035

THE JOURNAL OF PROSTHETIC DENTISTRY Gallardo et al