Conventional Laboratory Fabrication of Custom Healing Abutment

Bichacho introduced the cervical contouring concept for developing soft tissue architecture with a main focus on the marginal soft tissue level and the facial zenith position.^59,60 The cervical contouring concept involves modifying the implant level cast (through conventional sculpting of the sub-mucosal contour) and then using it for the fabrication of custom healing abutment.⁶⁰

The procedural steps for fabricating a custom healing abutment using the cervical contouring concept are shown in the following Table 2: ⁶⁰

Table 2.  Steps for Custom Healing Abutment using the Cervical Contouring Concept:60
1.	A conventional wax-up is created on the diagnostic cast.
2.	The cervical extent of the wax-up is traced circumferentially using a marker.
3.	The wax-up is indexed using laboratory putty which is then used to transfer the traced marking to the implant-level cast (recorded at the time of implant placement) (Figure 22). Figure 22.
4.	The cast is sculpted using laboratory rotary instruments (Figure 23) in the area slightly superficial to the implant platform up to the marked line such that there would be a smooth and gradual transition from the implant platform to the marked line. Care is taken to avoid nicking the platform of the implant analog. Figure 23.
5.	An engaging temporary abutment is attached to the implant analog on the modified cast. The space between the abutment and the marking is filled with a flowable resin material (Figure 24). The composite resin is polymerized using a curing light (Figure 25). Figure 24. Figure 25.
6.	The height of the temporary abutment is adjusted to ensure it does not interfere with the patient's occlusion.
7.	The modified temporary abutment/customized healing abutment is removed from the cast, the intaglio surface is evaluated, and voids if any are filled with the resin material and polymerized via curing light (Figure 26). Figure 26.
8.	The customized healing abutment is tried in the mouth, and may be further modified as necessary. It is finished, polished, and attached to the implant.
9.	A radiograph is taken to confirm the complete seating of the custom healing abutment.