Emergence profiles in natural tooth contour.

Part II: Clinical

considerations
Hurney &I. Croll, D.D.S.
;4.w l’.)rl , N.\‘.

Selection of the straight emergence profile in designing artificial crowns for teeth
has been shown to improve the effectiveness of oral hygiene near the gingival
sulcus. The axial profile of teeth can be viewed as a series of straight lines with
curved transitions. Reproduction of these geometric patterns facilitates fabrication
of restorations that appear natural. (J PROSTHET DENT 1990;374-9.)

P art, I of this study confirmed the straight emer- Interpreting emergence profiles as geometric shapes can
gence profile as the norm in naturally occurring axiogingi- provide guidelines for oral hygiene, restoration design, and
val tooth contour.’ Observations supporting a straight tooth preparation. A straight line and a curve meet at only
emergence profile as the normally occurring tooth mor- one point, the tangent seen in the left example in Fig. 1, A.
phology approximating the gingival sulcus, based on pho- Conversely, a straight line and a flat emergence profile can
tographic measurements, are a departure from traditional be adapted to one another, demonstrated in the right
concepts.’ The existence of a protective convexity in I he example in Fig. 1, A. The emergence profile affects the
gingival one third of a tooth presented by Wheeler3, 4 and convenience and effectiveness of oral hygiene procedures
others” implied a continuous curved surface in the gingival designed to remove bacterial plaque from natural and re-
third. The curved profile concept, although unsupported stored tooth surfaces. Toothbrush bristles and tooth picks
by photographic evidence, has been classically taught to used in conjunction with handles such as the Perio-aid
dental students and laboratory technicians by using line (Marquis Dental Mfg. Co., Denver, Colo.) device are
drawings in technical manuals and atlases. The curved straight in profile. In Fig. 1, B, the appropriate relationship
transition of axial tooth contour at the height of contour is of the oral hygiene device to the emergence profile is dem-
not always located in the gingival one third. onstrated.
Restorations designed and placed with straight emer-
gence profiles in the gingival one third provide the patients
Presented before the American Academy of Crown and Bridge with a shape that is accessible and facilitates oral hygiene
Prosthodontics, Chicago, Ill. recommended by Eissmann et al.fi and others.‘. s This same
10/l/10954 rationale is applicable in the convex tissue-facing surface

Fig. 1. A, Straight oral hygiene appliance and straight-curved emergence profile. The
curve and straight line meet only at tangent in left illustration. B, Convenient adaptation
of oral hygiene appliance and emergence profile of canine. Note relationship of this angle
to emergence profile of premolars posterior to canine.

374 APHIL VOLUME63 NUMBER4

EMERGENCE PROFILES IN NATURAL TOOTH CONTOUR: II

Fig. 2. A, Sectioned diagnostic cast of mandibular incisors demonstrates convexity on

lingual surface of mandibular incisors. Example on left has lingual convexity below gingi-
val tissue. Example on right has convexity above gingival tissue with tooth extruded and
gingival recessioncreating niche difficult to keep clean.B, Area on lingual surface of man-
dibular incisorswith bacterial plaque and calculus accumulation below lingually convex
emergenceprofile.
Fig. 3. A, Straight emergenceprofile selectedfor lingual surface of mandibular anterior
restoration to facilitate oral hygiene. 3, Completed restorations with straight gingival
emergenceprofiles lingually and openembrasureform below contact area to facilitate oral
hygiene from lingual surface.

of the modified ridgelap pontic, recommendedby Stein,g
with optimal contact of the dental floss,improving oral hy-
giene. A straight emergenceprofile will enable effective
reachingto the depth of the sulcusin closecontact with the
surface of the restoration. This is especially desirable on
the surface of the tooth beyond the cavosurfacemargin, to
facilitate removal of the accumulatedmicrobial plaque. If
the emergenceprofile of a restoration is convex in the gin-
gival one third, it is possible,but inconvenient, to remove
the bacterial plaque on the tooth surface contacting the
gingival sulcusbelow the point of tangency.
The lingual surfacesof mandibular incisors provide an
example where a convex emergenceprofile in the gingival
third is cornman.The sectionthri~ughthe central incisor on
the left sideof Rg. 2, A illustrates a mandibular incisor with
its convexity located subgingivally. The mandibular incisor
on the right aideof Fig. 2, A with a lingual convexity located
above the free gingival margin demonstratesthe niche be-
tween the height of contour fingually and the root surface.
In Fig. 2, B the calculus and bacterial plaque accumulated
on this surface are evident becauseit is inconvenient for
patients to maintain. A modification of the natural tooth
can create a surface that is more easily maintained by the
patient. Specifically, the lingual surface of mandibular in-
cisorsmay be restored with a straight erne~e~~ profile.
If the dentist choosesto extend the contact areabetween
anterior teeth from the incisal embrasureto the level of the
gingival papilla for esthetics,the lingual embrasuremust
be wide enoughfor accessto the gingival tiesue under the
contact areafrom the lingual surface(Fig. 3). When viewed
from the facial surface, rn~d~b~ ineisomhave straight
interproximal emergenceprofiles that begin at the end of
a long contact area and extend to the cementoenamel
junction (Fig. 4). If restorations follow this pattern, they

THE JOURNAL OF PROSTHETIC DENTISTRY 315

 CROLL

See opposite page for legends.

3 76 APRIL1990 VOLUME63 NUME ma.4

EMERGENCE PROFILES IN NATURAL TOOTH CONTOUR: II

Fig. 7. Mandibular canine, anatomic crown with concavity on distal surface.

Fig. 8. Emergence angle is +15 degrees in relationship to long axis of tooth.

can be esthetic and allow convenient interproximal thread- LABORATORY APPLICATIONS

ing of dental floss (Fig. 5).
Sectioned diagnostic casts reveal a flat facial emergence
profile in mandibular anterior teeth extending to a point
midway on the facial surface when viewed from the inter-
proximal aspect (Fig. 6). Similar to the maxillary canine,
the mandibular canine has a concavity below the contact
area of its distal surface (Fig. 7).
Tooth preparations must be perceptively designed to
accommodate dimensional requirements of restorative ma-
terials within the limits of the emergence profile. “Depth
cut” controlled shoulder preparations with a hollow-ground
bevel are an approach that meets these requirements. The
emergence angle (Fig. 8) made by the emergence profileand
the long axis of the tooth is +15 degrees. On the basis of
mathematical axioms, KuwatarO concluded that if the path
of insertion was parallel to the long axis of the tooth, all
metal ceramic restorations with cavosurface bevel angles
less than 35 degrees with the path of insertion should have
metal collars to prevent overcontouring and opaque expo-
sure.
If adequate space has been created for the restorative
materials during tooth preparation, retainers of fixed par-
tial dentures can be made with suitable emergence profiles.
Several waxing instruments have a flat surface to create a
flat profile in the marginal area of the wax pattern. The
convex side of the waxing instruments can develop concave
contours in the wax pattern such as the distal surfaces of
maxillary canines and mesial surfaces of the premolars
(Fig. 9). Mounted grinding wheels and sandpaper disks
have flat cutting profiles that can machine straight emer-
gence profiles and finish restorations during fabrication.
Clinically, the facial and lingual surfaces of restorations
can be easily evaluated for straight emergence profile with
a periodontal probe. Fig. 10 demonstrates restorations with
suitable facial emergence profiles. Interproximally, radio-
graphs provide the best picture to establish that the desired
emergence profile and adaptation between the restoration
and root have been accomplished (Fig. 11). The overall
axial profile of many dental forms are viewed as a series of
straight lines with curved transitions. Reproduction of

Fig. 4. A, Interproximal emergence profile of mandibular incisor extending from long

contact area to CEJ, anatomic crown facial surface. B, Relationship of natural anterior
teeth-contact areas and gingival tissue.
Fig. 6. A, Mandibular anterior teeth with long contact area and straight emergence pro-
file. B, Mandibular anterior teeth with long contact area and straight emergence profile on
pontic of mandibular lateral incisor.
Fig. 6. A, Mandibular incisor,sectioned diagnostic cast. B, Mandibular canine, sectioned
diagnostic cast. C, Mandibular canine anatomic crown with gingival overlay.
TEE JOURNAL OF PROSTHETIC DENTISTRY 377
 Fig. 9. A, Flat waxing instrument creates straight emergence profile in wax pattern. B,
Convex waxing instrument develops concave shape in wax pattern.
Fig. 10. A, Desired emergence profiles and emergence angles. B, Suitable emergence
profiles and emergence angles.

Fig. 11. A, Radiograph of natural interproximal emergence profiles. B, Completed metal

ceramic restorations seen radiographically with straight interproximal emergence profiles.

378 APRIL 1990 VOLUME 63 NUMBER 4

EMERGENCE PROFILES IN NATURAL TOOTH CONTOUR: II

these geometric patterns creates restorations that appear 2. Tjan AHL, Freed H, Miller GD. Current controversies in axial contour
design. J PROSTHET DENT 1980;44:536-9.
natural. 3. Wheeler RC. Dental anatomy and physiology. 3rd ed. Philadelphia: WB
Saunders, 1963;75-84.
SUMMARY 4. Wheeler RC. Complete crown form and the periodontium. J PROSTHET
DENT 1961;11:722-34.
Photographic data reveal that most normally occurring 5. Amsterdam M, Fox L. Provisional splinting-principles and technics.
emergence profiles are straight. Because one objective of a Dent Clin North Am 1959;3:73-99.
dental restoration is accurate replacement of missing tooth 6. Eissmann HF. Radke RA, Noble WH. Physiologic design criteria for
fixed dental restorations. Dent Clin North Am 1971;15:543-75.
structure with a reliable anatomic model, reproduction of
7. Youdelis RA, Weaver JD, Sapkos S. Facial and lingual contours of ar-
the appropriate emergence profile is essential. Selection of tificial complete crown restorations and their effect on the peridontium.
a straight emergence profile for designing dental restora- J PROSTHET DENT 1973;29:61-73.
8. Burch JG. Developing crown contours in restorations. Dent Clin North
tions facilitates the convenience and effectiveness of oral
Am 1971;14:611-8.
hygiene procedures approximating the gingival sulcus. 9. Stein RS. Pontic-residual ridge relationship: a research report. J PROS-
THET DENT 1966;16:251-85.
10. Kuwata M. Color atlas of ceramo-metal technology. St Louis: Ishiyaku
I thank Dr. R. Sheldon Stein of Boston, Mass. for suggesting the EuroAmerica, 1986;235-50.
subject for this research while I was a postdoctoral student in
Prosthodontics at Tufts University, School of Dental Medicine Reprint requests to:
from 1970-72. DR. BURNEY M. CROLL
901 LEXINGTON AVE.
NEW YORK, NY 10021
REFERENCES
1. Croll BM. Emergence profiles in natural tooth contour. Part I. Photo-
graphic observations. J PROSTHET DENT 1989;62:4-10.

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