What is an emergence profile in dentistry? How to create and optimize it? Most importantly, why does it matter?
In this article, we bring together 29 dentists and researchers to highlight different aspects of the emergence profile.
We support our points with evidence from academic articles, government agencies, regional and international dental journals, and reliable medical sources.
Let’s dive right in.
What is an emergence profile?
The emergence profile of a tooth is its outline as it emerges from the gums towards its crown.
Thus the emergence profile of an implant-supported artificial tooth is the structure of the implant abutment or crown as they erupt through the soft gums of the jaw.
1. Dr. Burney M. Croll: Why the emergence profile is important
Dr. Burney M. Croll wrote an article in the Journal of Prosthetic Dentistry in 1989. The article was entitled ‘Emergence profiles in natural tooth contour. Part I: Photographic observations.’
In this article, Dr. Croll emphasized that creating an appropriate emergence profile is essential to accurately replace any missing tooth structure.
Indeed, the emergence profile is necessary for the following:
- Maintaining the health of your gums
- Preventing plaque-retaining areas of the tooth
- Maintaining good oral hygiene
2. Dr. Peter Pizzi, editor-in-chief of Inside Dental Technology, on what the emergence profile does
According to Dr. Peter Pizzi, the emergence profile helps create a lifelike restoration by representing the shape of the tooth as it emerges from the gums.
Dr. Pizzi recommends the two following methods of creating tissue casts:
- Creating a cast using a solid untouched pour of the master impression or scan and a virgin die
- Creating a removable die alveolar cast.
Each of the methods helps the dental technician optimize the emergence profile.
3-6. Dr. Juan Wang DDS, Dr. Yiman Tang DDS, Dr. Lixin Qiu DDS, and Dr. Huajie Yu DDS on how emergence profile might reduce gingival margin recession
The authors published a research paper in Clinical Implant Dentistry and Related Research in 2022. The paper was entitled ‘Influence of buccal emergence profile designs on peri-implant tissues: A randomized controlled trial.’
They observed 21 patients who required a single mandibular molar tooth replacement. Among others, they observed the following in the patients:
- Gingival margin level change
- Initial emergence angle
- Buccal mucosal W/H ratio
- Marginal bone loss (MBL)
- Implant failure
- Implant complications
Their conclusion was that a restorative emergence profile based on the Width/Height ratio significantly reduces the gingival margin recession.
7-10. Dr. Minoru Sanda, Dr. Daisuke Sato, and Dr. Kazuyoshi Baba of the School of Dentistry, Showa University, Japan, on how to adjust an emergence profile
According to the above three dental professionals based at Showa University, the following three steps work as the guiding principles for creating an emergence profile:
- Facial emergence: to deal with the space between the implant shoulder and the gum margin
- Interproximal emergence: to provide support to the interproximal tissue
- Palatal emergence: to enable a smooth transition between the mucosal margin of the implant and the adjacent teeth.
The authors conclude that a properly optimized emergence profile reduces chair time and the number of sessions required for creating custom dental restoration appliances.
11-17. Dr. Stephen J Chu, Dr. Joseph Y K Kan, Dr. Ernesto Lee, Dr. Guo-Hao Lin, Dr. Leila Jahangiri, Dr. Myron Nevins, and Dr. Hom-Lay Wang on the creation of a restorative EP for single-tooth implants
Here we refer to the paper the authors published in The International journal of periodontics & restorative dentistry in 2019.
The authors argue that though the implant restorative emergence profile should be similar to the profile of the extracted tooth, in real life, the presence of the implant will enable biologic changes to the gum. That is why making an emergence profile based on the tooth is insufficient.
What is needed is a specific modification and customization of the profile so that the implant restoration provides an esthetic look when it heals.
Thus dentists believe establishing any guideline regarding the customization of the emergence profile is difficult and above consensus.
That is why individual implant placements are rarely identical.
However, they have created the following decision tree to reflect their thoughts regarding establishing an ideal emergence profile.
18-20. Dr. Sara Soulami, Dr. Dagmar E. Slot, and Dr. Fridus van der Weijden of the University of Amsterdam and Vrije on the relationship between the implant-abutment emergence angle and implant emergence profile
The dentists suggest that a higher prevalence of peri-implantitis of infections at the implant site may be connected to the convex emergence profile of the extracted tooth.
But they accept that this finding should be considered with caution as not enough research has been done on the topic.
21-23. Dr. Mark Bishara, Dr. Gregori M. Kurtzman, and Dr. Evan S. Krause in Compendium: How to establish an emergence profile to achieve natural-looking dental restorations
The methods that the authors used to develop a soft-tissue emergence profile of implant restoration included the following:
- Use of chairside custom healing abutments by adding composite resin
- Fabricating a temporary crown through a lab
- Fabricating a healing abutment through a lab
- Sending the emergence profile to a lab through a digital scan of the soft tissue
- The lab creates the emergence profile of the natural tooth by following the data supplied to them
The authors documented two clinical cases for this purpose. In both cases, the emergence profile helped create natural-looking dental restorations.
24-29. Dr. Rahul R, Dr. Omkar S, Dr. Gaurang M, Dr. Mayuri B, Dr. Avanti M, and Dr. Faizan K: Achieving the most desirable esthetics during implant placement
The dentists review three cases of treatment to draw their conclusion.
They begin by preserving the papilla and bone grafting, then move to fabricate a surgical guide before implant placement, and finally discuss the CAM-CAD method of designing the custom abutments.
The dentists use an intra-oral scanner to scan the patient’s mouth to make the CAD-CAM method highly efficient.
They take a second scan of the interim prosthesis given to the patient.
Then they superimpose the two scans onto each other to create an ideal emergence profile to ensure an optimal restoration outline.
A note from SupreDent
Creating a dental implant-supported crown with a natural appearance requires the establishment of a flawless emergence profile of the extracted tooth.
It is important to preserve the soft and hard tissues of the implant site. In addition, minimizing the duration of the treatment without compromising the durability and esthetic value of the restoration is also vital.
An emergence profile can help complete both parts of the job. But the dentist must know how to create and optimize it properly.
The emergence profile of an implant-supported restoration is determined by the outline and shape of the dental crown in relation to the tissues based around the crown at the gum line.
BOPT means Biologically Oriented Preparation Technique. It is applied to dental implants and natural teeth to ensure that the soft tissues around them provide excellent oral esthetics in the post-treatment period.
Croll BM. Emergence profiles in natural tooth contour. Part I: Photographic observations. J Prosthet Dent. 1989 Jul;62(1):4-10.
Peter Pizzi, MDT, CDT. The Importance of the Emergence Profile and Tissue Cast. Inside Dental Technology.
Dr. Juan Wang DDS, Dr. Yiman Tang DDS, Dr. Lixin Qiu DDS, and Dr. Huajie Yu DDS. Influence of buccal emergence profile designs on peri-implant tissues: A randomized controlled trial. Clinical Implant Dentistry and Related Research. 07 April 2022
Sanda, Minoru & Sato, Daisuke & Baba, Kazuyoshi. (2018). Optimization of Emergence Profile of Implant Prosthesis: A Literature Review. Scientific Dental Journal. 2. 31. 10.26912/sdj.v2i1.2088.
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