Dental Implants: Crown Margin Short?

Re do the crown , you will face gingival problems so take it out

Best thing is to remake crown and have peace of mind.Make sure you pack right size of chord to capture margins properly. Some times you may have to do gingivectomy to reduce soft tissue's thickness particularly in unesthetic zone. Or you can open flaps up to margins and make new properly fitting provisional and suture flaps back wait for few weeks and you will be able to capture margins better.

Did you create the margin on the abutment or was it the manufacturers "margin"? If you created the margin, the lab should have ended the crown at that point. If the margin was on a manufactured abutment, it may be too far below the soft tissue to be used as a crown margin. Ending the crown at the gingival margin or only 1mm below is what most dentists consider to be correct. There are potentially more problems that can occur by extending the crown margin too far, (to the manufacturer's margin) then by ending short. Please remember that the abutment is not a tooth root.

I think it will be a good idea to take an implant level impresion and send to the lab. if the implant is too deep , so you and / or the techitian can choose a proper abutment for the situation and manufacture a new crown , I do recomend if the case ( implant to deep ) you should conssider a lateral screw retained crown best wishes and hope you solve the problem

Mark from Nu Life makes very good point.It is better to keep margins shorter then too deep in sulcus,as it will be a great help to microbes to have nice colonzization site and also it is very difficult to clean extra cement form deep sulcus completely. If you are using stock abutment with shoulder and it is difficult capture margins,then as previous post suggested , take implant level impression and pour model with abutment attached to analog and take impression outside mouth, fabricate only coping and place coping over abutment in mouth and take pick up .This way you won't miss margins and will be able to have soft tissue model also for better esthetics. In case of stock abument with shoulder margins very deep, it is better to have custom made abutment with proper margins.

Dr. Bernardo is right on the money! Take fixture level imps whenever possible.By choosing to do so, all of the restoritive options are left open to you and your lab, UCLA, stock abutment, prepared stock abutment,milled abutment etc...Your lab can then fabricate the cement over crown directly to the abutment of choice(hopefully they will wax and finish the margins under 10x power magnification as we do)You will also eliminate heat transfer and potential screw loosening as well as saving valuable chairtime with a much more accurate restoration.Remember, by learning to take fixture level impressions you have the foundation to restore anything.

I have an interesting question..... What about the value of a Stepped Back Abutment and how that looks on a radiograph? Are we worried about decay... :)) All platform switched abutments look short and so the crown being short.....is that a problem except in an esthetic zone. Just some things to consider and oh.....if you are concerned about the problems with your treatment why even think about it...do it over..end of story

First, I would evaluate the location of the implant platform with respect to FGM, evaluate the soft tissue Bio-Type and decide upon the type of abutment, emergence profile, collar height, etc. If in the esthetic zone possible platform switching for esthetics, a whole lot of considerations and information that is needed to make decision. In any event, I would suggest that you cut the crown off and take a new fixture level impression (I prefer the "open-tray" technique, everybody has their thoughts on this), provisionalize and have new implant supported crown and abutment mfg. Please make sure that your impression post is "down" by taking an x-ray of same. Your laboratory may be able to utilize your abutment and you should probably still have your provisional or gingival healing cap that can be placed during the interim depending upon system used. When in doubt fix it. We all make mistakes and you just need to go back thru your steps and the mistake will probably become obvious to you. Thanks for sharing. Duke Aldridge, MICOI, MAGD

Duke's comments make sense. The occasional problem with cementation, besides the deep margin, lies in the thick gingiva and more often, lack of cement vent in the crown, thereby creating back pressure during cementation and eventually short margin and occlusal adjustment. Surprisingly gingival inflammation doesn't appear to be a problem especially in thick tissue biotypes. Still, removal of crown is advisable in case of doubt.

If the crown is not in an aesthetic zone and the patient does not mind the appearance then there is absolutely nothing to worry about. Why not just be open with the patient and inform them that you think you could produce a better looking crown if they would like it, but the one that they have would function perfectly well. If they are happy just write it all in the notes.

YES, BUT NOTED THAT IT WILL APPEAR IN ARCHIVED 8/06??? I am currently in 3 rd + yr of implant/crowm placement. I have a high smile & advice has been conflicting as to whether to have ‘large teeth’ or gingival tinted crown tops (flange prosthesis?) to approximate gingival tissue. I am also having a diastema between two front teeth. My original teeth were smaller than temps that I have been wearing with gaps between all & I feel that there is too much dentition in mouth. I’ve already had pink tint on temps & it looks totally false & cannot make a decison on permanents. I was not given this option at start as well as all other issues & complications I have encountered. I would sincerely appreciate any advice in this matter. Thank you.