I sometimes feel like I am playing that old game “Beat The Clock” when I am taking off anterior implant provisionals. This rushed sensation comes from an understanding of the role the provisional plays in creating and maintaining the shape of the soft tissue. I should take a step back, and explain that in the anterior I use the shape of the provisional over a period of weeks to months to sculpt the final position of the gingival margin on the facial and the interproximal papilla, within the limits created by the position of the fixture, bone and tissue.This process. much like that of creating an ovate pontic site, is delicate. Once the tissue is mature I want to be able to transfer the soft tissue position accurately to the laboratory so they can fabricate an exquisite restoration.
After placing the provisional, there are many appointments that require removing it and maintaining the newly developed tissue profile, from re-contouring to taking the final impression. In a matter of moments after the provisional is out of place it is easy to visually see how the tissue form begins slumping. This is also apparent when I replace the provisional and watch the tissue blanch and the patient respond if they are not anesthetized. Hence, the root of feeling rushed and trying to work fast enough that I can capture an accurate soft tissue impression. The other day I was confronted with this exact dilemma, while needing to adjust the emergence profile of an implant provisional.
I have my assistant set out our Mach II die silicone during these procedures with multiple tips. Die silicone, sets up as a rigid material, in under 45 seconds. I have the gun at the ready, and as soon as the provisional is out I inject the Mach II into the fixture and fill up the tissue profile. Once set the material will hold the shape of the tissue, and is easily removed with an explorer anytime I need to pop it out. You can pop it out, and then replace it, but I usually just grab the material with a new tip and inject again, versus trying to position it accurately.