A detailed decision tree to create, preserve, transfer, and support the emergence profile in anterior maxillary implants using custom abutments.

Rehabilitation with implants in the esthetic zone is one of the most demanding tasks due to the importance of obtaining an optimum esthetic result. The aim of this article was to present a workflow to create, preserve, transfer and support the emergence profile in anterior maxillary implants. Different methods are used surgically as well as prosthetically to construct an ideal restoration. When immediate loading can be applied in cases of increased primary stability, a provisional restoration is placed with occlusal contacts. In cases not permitting the above procedure and requiring extensive augmentation, a resin-bonded partial coverage fixed partial denture can be a predictable and reliable treatment option until the final restoration is delivered. Creating or preserving the emergence profile at immediate post-extraction and delayed implants, respectively, is achieved through customized provisional, healing abutments, a combination of prefabricated healing abutments and partial coverage provisional restoration, or utilization of the patient's own tooth crown. Transferring the individualized soft tissue contour to the final restoration can be achieved by modifying the impression coping intraorally with composite resin, fabricating a cast mimicking the soft tissue contour in the laboratory, or by the use of CAD/CAM technology. A customized abutment is necessary in order to maintain the emergence profile that has been created during the previous stages. The objective of this paper was to present a detailed workflow for the restoration of anterior maxillary implants focused on the creation, preservation, support, and transfer of the emergence profile of the soft tissues through a series of clinical cases.