Single centrals can be tough, but throw in the fact that it is an implant, and it can be even more complicated!
In my opinion, one of the more difficult things can be the tissue. We are always very careful to discuss with the patient that the tissue may never be symmetrical, or as full as with the previous tooth, or adjacent teeth. It takes time, and usually some sculpting to get it to the best it can be. Luckily, excellent periodontists are well aware of this, and manage this nicely.
In this case, we actually did NOT do any tissue forming. Because of the depth of the implant and tissue level, I designed the emergence profile within the CEREC software to as close to ideal as possible. At insertion of the abutment, the blanching of the tissue was present but not so much to positively restrict blood flow. By the end of the appointment, the tissue was regaining color.
After the abutment and crown (Ivoclar Vivadent, eMax CAD) had been milled, they were crystallized. The abutment was bonded to the TiBase (DentsplySirona.) While staining an abutment can be difficult, it is no worry that the stain goes over the margin because it can easily be removed if necessary. Using a spray glaze is contraindicated, in my opinion, because there is no control of covering the portion to receive the crown.
After passive seating of the crown occurs, try-in pastes can be utilized to draw the shade of the final product slightly up or down. The crown was the HT high translucency option of eMax CAD. With this, the resin cement showthrough will be subtle, but just enough to make a slight difference. In this case, we chose to match the majority of the teeth, and not the slightly darker left central. The try-in pastes come from the Variolink Esthetic line of resin cements (Ivoclar Vivadent.)
After the restoration was finally torqued to the implant and the crown bonded, a post op x-ray was taken. The value of the new restoration is inline with the majority of the maxillary teeth.
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