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What must be verified before restoring an Implant Crown and Bridge, including integration, healing, and sulcus preparation?

Implant restorations do not involve tooth reduction, so the preparation that matters is site readiness: confirming the implant has integrated, allowing adequate healing, and shaping the soft tissue so the final restoration is hygienic and esthetic. Skipping these checks is the most common cause of an otherwise well-made restoration failing to seat or fit.

Confirm integration before you begin

The restorative workflow starts only after the implant has been checked for integration, typically two to three months after placement. The implant must pass the percussion test and sound solid, and a radiograph must confirm there is no bone loss, non-integration, or fenestration that would prevent proper restoration.

Allow the healing period with proper abutments

If the implant was placed using a two-stage protocol, a healing abutment (gingival former) should be seated, and a healing time of at least two weeks should be observed between surgical exposure and impressions. The healing abutment should be sized to represent the tooth being replaced at the gum line in its natural state. Choosing the right size allows the crown to be contoured to match the patient's existing teeth without extensive porcelain work, producing a more hygienic and esthetic result with a properly formed sulcus before fabrication begins.

Verify the tissue, then shape the sulcus

At the restorative visit, remove the healing abutment and verify healthy, pink peri-implant tissue with no signs of inflammation or recession around the implant platform. If the surgeon did not use a custom healing abutment to shape the sulcus to your specifications, this is the optimal moment to shape it, using an impression post placed temporarily to form the desired sulcus and neck position of the tooth.

Clinical rule of thumb: proper sulcus shaping improves the odds of a hygienic, esthetic implant crown and reduces the long-term risk of peri-implantitis from bacterial infiltration around a poorly contoured restoration.

The table below summarizes the gating checks before impressions.

Prerequisite What to confirm
Integration Percussion test passed, solid sound, radiograph clear of bone loss, non-integration, or fenestration
Healing (two-stage cases) Healing abutment seated, at least 2 weeks before impressions
Healing abutment sizing Represents the replaced tooth at the gum line
Tissue health Pink, no inflammation or recession at the platform
Sulcus form Shaped to the desired neck position before fabrication

Once these are satisfied, proceed to records capture as described in the records and impressions article.

 

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