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Interference from the Gingiva in Overdenture Treatment: Recommendations?

Last Updated: Jun 02, 2010

Dr. LT asks:
I have an edentulous patient who has been treatment planned for an implant bar-retained, tissue supported overdenture. The implant fixtures are well placed, stable and have no pathological signs or symptoms. I have not been able to try in the abutments and bar because of interference from the gingiva. After removing the healing abutments which were supposed to form ideal gingival contours, the gingival tissue rebounded and partially covered the implant platforms so that I could not completely seat the abutments or try in the bar. I tried to use mechanical retraction with cord, cotton and epinephrine but the gingival tissue kept interfering with the seating. At this point, I can do some surgical gingival recontouring to free up the implant platforms, but I would like to avoid surgery and I would like to preserve as much keratinized gingival tissue as possible. I could also try to insert wider transmucosal gingival healing abutments to try and mold the tissue off the platforms and create more space. What do you recommend?

4 Comments on Interference from the Gingiva in Overdenture Treatment: Recommendations?

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DR. M.Ali DDS, MS

8/3/2010

Dear DR.LT , interference of gingival tissue around the implant fixture and the abutment is common if you have more than 2 mm of thin gingival tissue. surgery is the treatment of choice to eliminate the unwanted tissue.more than 2 mm tissue is collecting bacteria and produce terrible odor, especially bio type 2 and 3. also in overdenture the junction between the fixture and the abutment is not critical.to eliminate the tissue you can put the abutment and release the interference of the tissue by blade then take the abutment out and clean the area from any tags then put it back. or if the tissue is thin and floppy , it should be totally eliminated . if you can't put same size abutment it will be difficult to put wider healing cap without surgery . remember if the tissue is the issue the bone set the tune. good luck DR.M.Ali DDS,MS New York

8/4/2010

You thinking too much....couple of things that may ease your pain, anesthesia, tissue punch, with right diameter to your components, and move on...second option...place component as best you can,as to gage size of gingivae to be remove, place plastic straw, over abutment, and electrosurge...this prevents contact of tip to the implant....I hope this helps, incovinience minimal..

cory c.

8/5/2010

you ARE thinking too much.tissue punch the healing cap w/ same diameter.why are you using a bar when individual attachments come w/ different cuff heights? unless your implant spread isn't really wide across the arch, you'll get the same retention w/ half the hardware and one third the lab cost.

Richard Hughes, DDS, FAAI

8/6/2010

A bar is better because it splints the implants.

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