Alveolar Mucosa Growing over the Implants and Locator attachments: How to Control This?

No, you can't. In this kind of situation (lingual undercut) co- axis implants can sometimes be the solution, but too late for that now. If the implants aren't integrated better have them removed, if they are, the patient's in for a lot of trouble, and so are you. Higher locators; local hygiene with chx gel and excision of excessive mucosa on a regular base are all you can provide...

I had a similar case recently,except that the implants were placed labially in the anterior mandible. After excising the excess tissue only to have it grow back almost immediately I finally resolved the problem by placing longer abutments. Worth a try. Good luck!

Sorry to hear about your frustration. Could you please verify that you have a zone of attached gingiva circumferentially around the implant? From what I gather, you only have mucosa. IMHO not ideal for overall implant health. If this is the case consider grafting this area to provide optimal tissue zones.

I am having a little difficulty understanding what is happening. Usually in the severely resorbed mandible, the ridge shrinks downwards and forwards, so I am having a little difficulty visuallizing lingually placed implants. To me, lingually placed implants in a severely resorbed ridge means the implants are placed in the sublingual space.Clearly I have got the wrong picture. However as to your dilemma about the gingiva growing over the implants, this usually occurs because there is a space available to allow the gingiva to grow into. Perhaps the denture need relining.

clinical pictures & digital pano. will help us understand your predicament.

Agree, it would be useful some pictures. I'm confused, but with the information you gave and the implants are paralel enough, you can use transmucosal abutments or higher locators. Or "Castable locators", so your lab can do some personalized abutments and give them the proper angle and height. http://www.zestanchors.com/images/articles/article_117_LOCATOR%20IMPLANT%20QUICK%20REFERENCE%20GUIDE.pdf

Wonder if it is anatomically possible or impossible to send to a surgeon for some vestibular push back (of mucosa) and if possible, graft in a small bit Mucograft or a thin free gingival graft. I did this for a case with implants labially placed in mucosa with locator attachments and it helped. This would be difficult if not impossible if there is no vertical bone height left and it is level with the floor of the mouth. Please post some photos if you can.

This is why surgeons must begin to master the mini implant technique, which avoids all of this problem! Go to a course. It's just another tool, stop using the wrong tool! Take em out and refer for minis after healing!!

Dr. L recently posted case photos to go along with this question. Please refer to the recently uploaded case photos at the top of the page. Thank you.

Thanks for photo and X-rays, this is precisely what I a referring to in my comment, ideal mini case, lousy standard case, get with the standard of care or insist in cbct guided surgery with soft tissue augmentation by your surgeon for standard implant placement, you are responsible for results, not recommendations! Good luck. Ps: At least attend a mini implant course to understand the options for atrophic mandibles, you do not have to place if you don't choose to, but your patients deserve to know all of their options! Then find a surgeon willing to offer both options above, case can be handled either way, but not if standard plan is inadequate!

Smiledoc, minis are not "the standard of care", in this situation. The vestibuloplasty is a good suggestion, but should it have been done pre-impant? Retrospectivly, this patient would have been better served, with the implants further back and approaching the inferior border. Sorry, for the "armchair bomb"! Does she have a yeast infection?? Bv

Since the implants appear to have been placed in the FOM, minis maybe a better alternative. They can simply be removed, with little or no trauma. Bv

Thanks for posting the photos... they are worth a thousand words! Here's what I'd do: 1) Vestibuloplasty or at least a partial one. 2) Replace locator abutments with corrected tissue heights (once the implants are surrounded by attached gingiva.) 3) reline plate for new tissue height/new locators 4) get hug from patient because you figured out "what the problem was" and corrected it! LOL I'd call the surgeon who placed the implants and ask him/her to rectify this issue immediately. Thorough treatment planning of this case would have told you and the surgeon that the patient will need soft tissue surgery along with the implants. Sorry that you learned this the hard way. Now, the patient is looking at YOU (inappropriately) as "the guy that can't make my denture fit". You will NEVER correct this without attached gingiva surrounding the implants, nor could you expect the implants to have a long life! I hate to say it but whoever placed the implants for you needs some training in BASIC implant principles! ie what kind of tissue should surround the implants, and how much of it! (2mm of attached gingiva all the around is ideal!) Hope that helps!

These implants must be coming out of the submandibular ducts ! There is attached tissue, it happens to be where the implants belong. My advice, in this situation, is to "sleep" these impants, assuming they are bone level, with the covers on and if not, remove them and graft the area and place the implants where they belong; just in front of the anterior aspect of the mental nerve and as close to the inferior border as possible. If a cbct scan would have been utilized, with or without a guide, this would have been avoided, most likely. I would also advise the surgeon that placed these, "to help out ".sorry, if this seems harsh, but until the implants are in the correct position, you will be "chasing your tail". Bv

Remove locator abutments and placed a bar with overdenture clips.

Jim, I'm not sure that can be done, effectively . Again, I don't restore implants, but I do know where they belong and if I don't , I ask. Can you put angled abutements and a bar on these?? Bv

Dr. L, I'm afraid the answer is no. Even if you were to detach the genial tubercles and reposition the attachment of the genioglossus muscle and have someone do a splitthickness skin graft, these implants are essentially good for one thing, and that is preventing atrophy. Maybe you could sent it to an ENT!!??

It would be good to know the brand of the implants placed......in any case most of the manufacturers are making angulated Trans Mucosal Abutments ( TMA's ) These specialized abutments, available from Adin Dental Implants of Israel, would work for most internally hexed implants, have the distinct advantage of being angulated, so that they would reposition the emergence profile and add height to clear soft mucosal tissue; and the locator attachments could be fitted and the problem solved. Gerald Rudick dds Montreal, Canada

Consider custom made abutments for the root forms, a mandibular subperiosteal implant, or a ramus frame implant.