Table Of ContentSoft Tissue Management:
The Restorative Perspective
Putting Concepts into Practice
Soft Tissue Management
THE RESTORATIVE
PERSPECTIVE
Putting Concepts into Practice
Ariel J. Raigrodski, ,
DMD MS
Professor
Department of Restorative Dentistry
School of Dentistry
University of Washington
Seattle, Washington
Private Practice
Kenmore, Washington
Quintessence Publishing Co, Inc
Chicago, Berlin, Tokyo, London, Paris, Milan, Barcelona, Istanbul,
Moscow, New Delhi, Prague, São Paulo, Seoul, and Warsaw
Dedication
To my parents, Noa and Pinchas Raigrodski, who gave me the love and foundation to be who I am.
To my wife, Dana, for her endless love, patience, understanding, and unconditional support.
To my children—Daphne, Tal, and Maya—who make it all worthwhile.
And to all my teachers—past, present, and future.
Library of Congress Cataloging-in-Publication Data
Raigrodski, Ariel J., author.
Soft tissue management : the restorative perspective : putting concepts
into practice / Ariel J. Raigrodski.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-86715-691-1
I. Title.
[DNLM: 1. Dental Implantation. 2. Dental Prosthesis. 3. Guided Tissue
Regeneration, Periodontal. 4. Periodontium. 5. Technology, Dental. WU 640]
RK667.I45
617.6’9--dc23
201404616
© 2015 Quintessence Publishing Co, Inc
Quintessence Publishing Co, Inc
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All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in
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publisher.
Editor: Leah Huffman
Design: Ted Pereda
Production: Kaye Clemens
Printed in China
Contents
Foreword vi
Preface vii
Contributors viii
List of Cases and Treating Clinicians x
1
Fundamental Concepts of Periodontal Tissues 1
2
Preparation Design: Minimizing Soft Tissue Trauma 29
3
Therapeutic Provisional Restorations 43
4
Impression Making: A Clinical Perspective 85
5
Accurate Transfer of Soft Tissue Contours
to the Dental Laboratory 103
6
Abutment Selection for Cement-Retained
Implant-Supported Restorations 127
7
Ceramic Screw-Retained Implant-Supported
Restorations 147
8
Delivery Procedures 171
Index 189
Foreword
What is the definition of a “true” teacher? The answer lies in understanding what the under-
lying goals and objectives are in conveying knowledge. A “true” teacher shares the gift of
wisdom and experience without the expectation of receiving anything in return. It is this act
of sharing in itself that yields fulfillment.
In a dental world filled with both academic and clinical rivalry, it is unusual today to find a
teacher who is not driven solely by the need to “self-promote” and to continually create
opportunities to showcase his or her most successful treatment outcomes. It is with this
in mind that Dr Raigrodski has written a book for our profession in which he teaches with
no other reason than to share his knowledge with dentists who will greatly benefit from its
content.
This book is dedicated to providing a better understanding of the soft tissue–restorative
interface and its influence on the final restorative result. It provides a simplified, well-
organized, evidence-based, step-by-step approach to achieving esthetically pleasing restor-
ative outcomes.
To achieve a predictable soft tissue outcome around natural teeth or dental implants re-
quires not only strict discipline in the clinical protocol but also a keen understanding and
control of tooth contour and emergence profile. As this text illustrates—with superb detail
and interdisciplinary treatment—the ultimate challenge lies in all of the fine details and nu-
ances of crafting the provisional restorations as well as the definitive ones.
As with all experienced teachers, Ariel has recognized the value of collaboration on a project
of this magnitude. As you make your way through this textbook, you will begin to appreciate
the level of commitment that the University of Washington graduate students have made
with their own teaching contribution to the profession. There was great sensitivity to pre-
senting information in a way that would be clearly understandable and most user-friendly.
Soft Tissue Management: The Restorative Perspective will provide substantial and tangi-
ble tools to restorative dentists, which will subsequently help them become more “com-
plete” clinicians to their patients. As dentists become more capable of controlling the “soft
tissue frame,” they will better be able to meet or exceed their patient’s ever-demanding
expectations.
Gerard J. Chiche Michael Cohen
Augusta, Georgia Seattle, Washington
vi
Preface
Ten years ago, I was invited to give a lecture on how to manage soft tissue from the per-
spective of the restorative dentist. The request came from a group of dental practitioners
who had been working comprehensively in an interdisciplinary manner to provide better
care for their patients. However, many times they were frustrated with the definitive treat-
ment outcome in terms of how the restorations blended with the soft tissue. I carefully
developed the lecture, and with time it grew into a program, with inspiration from my gradu-
ate students, colleagues, and mentors as well as my experience in private practice. It has
culminated in this book.
Soft tissue management from the restorative perspective is a topic that is fundamental for
success in providing patients with esthetic and functional restorations and for improved pa-
tient care. This is where the beautiful artistic work of the dental technician meets with the
finish line of the tooth preparation and with the dentogingival complex at the soft tissue–
restorative interface. Creating and managing the soft tissue frame is the essence of restor-
ative dentistry, and it is a constant challenge for clinicians, regardless of the type of restora-
tion (tooth borne or implant supported) being provided. In every step of restorative therapy,
the soft tissue may be susceptible to trauma that may or may not be reversible and may
adversely affect the desired esthetic outcome.
Much has already been written on this topic from both research and clinical perspectives.
The vision for this book, however, is to provide clinicians with evidence-based concepts
that will guide them as technologies and materials in dentistry continue to evolve. The goal
is to demystify clinical restorative procedures and help restorative dentists ensure better
control of the soft tissue frame (also known as the pink esthetics) during all clinical steps of
restorative therapy while enhancing a healthy and esthetic treatment outcome. Therefore,
the book offers a simplified approach for soft tissue management during restorative therapy
and practical tools that restorative dentists may apply in their daily practice.
Writing this book provided me with a great opportunity to learn more and augment my
knowledge and clinical skills. I can only hope that this book similarly provides restorative
dentists with practical, tangible, and valuable tools based on sound scientific concepts that
will help them in their everyday practice.
Acknowledgments
First, I would like to thank all the contributors to this book as well as all the faculty members at the
University of Washington, especially Deans Martha J. Somerman, Timothy A. DeRouen, and Joel H.
Berg. In addition, this book would not be possible without the inspiration and collaboration of my
graduate students in the Graduate Prosthodontics program. I am also in debt to all the clinicians and
dental technicians (including Kimiyo Sawyer and her team from Cusp Dental Laboratory) whose excel-
lent work is depicted in the cases presented in this book (see page x).
Carole Green and Jeff Meadows from the Graduate Prosthodontics clinic and my office manager,
Paige Moody, have offered me significant support and assistance, for which I am grateful. Many
thanks as well to Heather Bright from the Seattle Study Club and Michelle Butcher from the Graduate
Prosthodontics program.
I am also grateful for the education I received at the Hebrew University School of Dental Medicine in
Jerusalem, Israel, and at Louisiana State University School of Dentistry.
My deepest appreciation and gratitude go to my program director, Israel M. Finger, and my master
research mentor, Shawky E. Mohamed, for their wisdom and guidance. Finally, I must express my
eternal gratitude to Gerard J. Chiche, who continues to inspire me as an excellent teacher, superior
clinician, and a genuine human being, and Michael Cohen, who has inspired me to write this book and
continues to be a mentor, a friend, and a family.
vii
Contributors
Matthew R. Anderson, dmd, msd, earned his DMD degree from the University of
Pennsylvania School of Dental Medicine, after which he completed specialty train-
ing in prost hodontics at the University of Washington School of Dentistry, where
he earned his certificate and MSD degree. While there, Dr Anderson was named
the David L. Wands Fellow and also received a fellowship from the American Den-
tal Association & Dentsply International. His research during his residency earned
him a Tylman Grant and award from the American Academy of Fixed Prosthodon-
tics. Dr Anderson maintains a private practice in Santa Rosa, California.
Sami Dogan, dds, dr med dent, received his dental degrees from the University of
Ankara, Turkey, and from the School of Dentistry at the University of Hannover,
Germany. He completed his postgraduate training in the Department of Restor-
ative Dentistry at the University of Washington. He is currently an assistant
professor at the University of Washington in Seattle, where he teaches dental
and graduate students. Dr Dogan’s research includes clinical and in vitro studies
and focuses on remineralization of teeth and the quality assessment of dental
materials. He has published extensively in peer-reviewed journals and holds an
intramural practice limited to prosthodontics at the University of Washington.
Sul-Ki Hong, dds, received his dental degree from the University of São Paulo,
Brazil, where he then entered the postgraduate program in prosthodontics and
taught both prosthodontics and periodontics. He received his certificate in peri-
odontics from Nova Southeastern University in Florida and is a Diplomate of the
American Board of Periodontology. Currently, he is a clinical assistant professor
in the Department of Periodontics at the University of Washington. He also
maintains a private practice limited to periodontics in Bellevue, Washington.
Motoaki Ishibe, dds, msd, received his DDS degree from Nihon University
School of Dentistry in Tokyo, Japan, where he also completed a 1-year resi-
dency in general dentistry and served as a resident in oral and maxillofacial sur-
gery. He further pursued his postgraduate training in prosthodontics at the Uni-
versity of Washington, where he received his specialty certificate in
prosthodontics and MSD degree. He is currently an affiliate assistant professor
in the Department of Restorative Dentistry at the University of Washington. He
also maintains a private practice in Kofu, Yamanashi, Japan.
Jae Seon Kim, dds, msd, received his DDS degree from Yonsei University Col-
lege of Dentistry in Seoul, Korea, and his MSD degree and certificate in pros-
thodontics from the University of Washington School of Dentistry. He is cur-
rently an assistant professor in the Oral Rehabilitation Department at Georgia
Regents University College of Dental Medicine in Augusta, Georgia. He is also
part of the esthetic team in the Ronald Goldstein Center for Esthetic and Implant
Dentistry. Dr Kim is a Diplomate of the American Board of Prosthodontics and a
Fellow of the American College of Prosthodontists.
viii
Robert M. London, dds, received his dental degree from the University of Cali-
fornia–Los Angeles School of Dentistry and his certificate in periodontics from
the University of Washington in Seattle. He has held previous appointments at
Nova Southeastern University and the University of Southern California School
of Dentistry. Dr London is currently a clinical professor of postdoctoral periodon-
tics at the University of Washington. He is a member of the editorial review
boards for the International Journal of Oral & Maxillofacial Implants, the Journal
of Periodontology, and Clinical Advances in Periodontics as well as a consultant
for the Washington State Department of Health. A Diplomate of the American Board of Periodon-
tology, Dr London has researched bone grafting, guided tissue regeneration, physiology of implant
surface–bone interactions, and implant therapy, including esthetic and tissue responses to custom
CAD/CAM abutments. He has also published several book chapters and scientific articles in peer-
reviewed journals and lectures extensively both nationally and internationally.
Takafumi Otani, dds, phd, msd, received his DDS degree from Osaka University
School of Dentistry in Japan, where he continued his studies in the Graduate
Fixed Prosthodontics program, receiving his PhD. After maintaining a private
practice in Japan and teaching at Osaka University for 3 years, he enrolled in the
Graduate Prost hodontics program at the University of Washington, where he
received his certificate in prosthodontics and MSD degree. Dr Otani is currently
an affiliate assistant professor in the Department of Restorative Dentistry at the
University of Washington and maintains a private practice in Seattle. He also
lectures both nationally and internationally.
Tijana Stijacic, dmd, msd, earned her DMD degree from the University of Mani-
toba, where she graduated at the top of her class. After practicing as a general
dentist in Winnipeg, Canada, she earned her certificate in prosthodontics and
MSD degree from the University of Washington. Dr Stijacic is a recipient of
multiple awards within the dental community and maintains a private practice
limited to prosthodontics in Houston, Texas. She is also a part-time clinical as-
sistant professor at the University of Texas Health Science Center at Houston,
where she continues her involvement in dental research.
Robert D. Walter, dds, msd, received his DDS degree from Loma Linda Univer-
sity School of Dentistry in California. Ten years later, he completed a 3-year
graduate program in prosthodontics and earned his MSD degree at the Univer-
sity of Washington. He is currently an associate professor in the Department of
Restorative Dentistry at Loma Linda University School of Dentistry, a Diplomate
of the American Board of Prosthodontics, and a Fellow of the American College
of Prosthodontists.
ix
