One of the great challenges with implant care is having excellent gingival esthetics around the site. Implants at this time are flat, in a biologically contoured area. Attempts have been made to make contoured implants. I do picture a time where we will take a scan of the extraction socket and mill a custom dental implant for that socket right at the time of extraction and it will have matching contours. For the time being, we do have to compensate for this.
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Papilla forms are dependent upon bony projections extending above the CEJ to support the tissue position and health. This is a special problem when we are dealing with multiple implants next to each other. We can mask this by trying to make the gingiva thicker and this can be done by grafting dense or thickened mucosa in these areas.
In the esthetic zone, we tend to submerge implants slightly so that we get a minimum of 3 mm of gingival height facially. In the posterior regions, the tissues are often thin and firm and so we will often have 2 mm tissue heights on the facial aspect of a dental implant site. This is great for cleansing, but makes esthetic restoration challenging.
We can help this through building up these tissues either at the time of extraction and bone grafting or subsequently as an interpositional mucosal graft. Again, the desire would be to get 3 or 4 mm of thickened tissue especially to the facial aspect which gives some cosmetic coverage to the abutment and the base of the crown. The tissues can be simultaneously thickened interproximally to improve the papilla forms.
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The trade off is that this leaves some increased pocketing. The good news is that the newer implant designs do have a roughened titanium surface at the level of the biologic width and it has been found that the gingival fibers like to cinch down and “attach” around this area when the tissues are healthy.
My challenge at the time of implant treatment is to effectively teach patients the benefits of thickened tissue contours and get them to accept the possibility of additional cost and treatment. The tissue grafting procedures can always be done down the line after they have the teeth, but they are certainly best done prior to restoration.
As a team, our goal is to be looking at these tissue contours and expected tissue height, and to anticipate these cosmetic challenges. This will allow us to encourage patients toward appropriate care.
For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.
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