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Copious soft tissue bleeding 2 wks after uncovery surgery?

Last Updated: Dec 08, 2014

I installed a Zimmer 3.7×10 tapered screw vent implant in #9 site [maxillary left central incisor; 21] without any complications. The implant healed well and at 6 months, I did a state 2 uncovery and placed a Zimmer 345 transmucosal healing abutment. The patient returned 2 weeks later for the final impression for the crown. I noticed that the soft tissue around the healing abutment was red and bled copiously. I also noted that there was not much keratinized tissue around the implant, especially on the buccal aspect. The patient is on 325mg aspirin daily. The tissue thickness above implant is about 4 mm. What should I do to deal with this bleeding problem? Will the permanent abutment help the soft tissue to heal? Anything I should do to avoid this situation? I am more concerned about the long term impact of this on the peri-implant tissue health.

3 Comments on Copious soft tissue bleeding 2 wks after uncovery surgery?

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Rand

12/9/2014

If you take impressions 2 weeks after uncovering, this tissue will be delicate at best and would bleed easily. Wait another 2-6 weeks and it will get better. If you have insufficient attached gingiva, you should do a soft tissue graft. Many do not worry about this and is never a problem, except when it is. It can bite you later.

Dr Bob

12/9/2014

At 2nd stage surgery the incision can be made along the palatal aspect of the implant instead of over the center of the implant. This can often allow attached gingival tissue to be positioned facial by sliding the small flap apical on the facial. The attached gingiva that was covering the implant may then at times provide for some facial keratinized gingiva.

peter Fairbairn

12/10/2014

Deal with this now rather than have the fall out later , no keratenized gingiva in the Aesthetic zone will spell disaster in the long run . Dr Bob is correct take the cap off and allow to heal then take the tissue more from the palatal aspect and move it buccally . But there may be an issue with a lack of buccal bone here as if you had true host bone you would have attached gingiva in this area ..... So maybe raise a small flap to assess ( if you have used a HA based graft ) this is the only way to assess the plate. You cannot hope things get better if the basics are unsound . Good Luck Regards Peter

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