Implant 5mm Below Gingival Margin: Should I Be Worried about Future Bone/Gingival Recession?
Dr. P asks:
I have received an implant case that appears to be 2-3mm below the crestal bone level. I sounded it and it’s 5mm below the gingival margin. It’s been placed for about 3 weeks and according to the pt’s chart its a 4.7X 11.5 Implant Direct ReActive and was placed at the time of extraction #4 due to recurrent decay under crown. no PARL noted and had a demineralized bovine bone graft with collaplug cover. What should I do? I’m worried about future bone/gingival recession. I’m wondering if I should tell the pt it was not placed in the ideal position and needs to be redone before integration or if the depth is not that bad? The pt has just moved to the area so giving her back to the placing Dr is not an option. Any thoughts?
4 Comments on Implant 5mm Below Gingival Margin: Should I Be Worried about Future Bone/Gingival Recession?
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Tyler
6/28/2011
Between Implant and Natural Tooth the average papilla length you'll get is 4mm from the crest. You will likely see ~1mm of recession in this area, and unless you're platform switching you'll also likely see the 2mm of bone supra-implant loss. However, you're not in the esthetic area, so if the fixture is integrated you'll likely be able to restore.
Dr. Martin
6/28/2011
Without havibg seen the xray/clinical photo, I think you shouldn't have any worries. In particular if it is a platform switched system, where the protocol is placing subcrestally about 1-1,5 mm. Have in mind that the implant was placed immediately in a fresh socket after extraction, and some natural bone resorption will therefore be expected, which presumably is the reason why the dentist placed a bit deeper in the socekt.
John Manuel DDS
6/29/2011
The shape of the coronal end of the implant will have an effect upon the future of the site if it is so abrupt as to interfere with circulation in the tissue/bone there. A tapered top allows more Facial circulation at the eruption point.
As mentioned, placement upon extraction, especially in a div 3, flared anterior, will suffer greater initial resorption. 5mm is my target in these situations.
Regardless of the situation now, it is certain that a patient will have less bone and tissue tomorrow than they have today. The possibility of needing future tissue revision is always present in any case.
Baker vinci
7/9/2011
I'll be brief in that I've responded to every question. Absolutely tell the patient it might not be ideal, and at just three weeks, the implant can easily be backed out and a longer implant can be placed. The other responses may be acceptable ,but without being there and seeing either a ct or the patient, none of us can predictably give you any worth while advice . I think you should give the doctor that placed it the first shot at correcting this" potential problem". B. Vinci
