Scalloped Bone/Tissue Implant Case: How Does the Interproximal Bone Respond?

If the implant-abutment connection is "gap free" or you use "platform switching" on the restorative abutment, I don't think you will have much problem with interproximal bone resorption. However, I would place a provisional restoration out of occlusal contact, to prevent losing the interdental papillae. Hope this helps

Dear Dr H If the interproximal bone is far away enough(about 1.5mm), the bone level should be fine. If the adjacent interproximal bone is too close to the implant platform level (assuming there is no polished collar placed sub crestally), the interproximal bone will suffer and be reduced accordingly.

It looks pretty good from the X rays given. I don't think you are going to have much of an issue here. some resorption is expected no mater what, but if you have adequate interproximal bone thickness(1.5-2 mm )minimum resorption is negligible and insignificant. Thickness of your gingiva, and whether the periosteum is intact(meaning non-full flapp entry) during extraction and implant placement will play a role. Blood supply ! blood supply ! But looks good on the X ray ! Hope this helps. Sherman

Dear Colleague, I would like to answer you with a question,If the IP bone height is 5 mm above the implant abutment connection and the buccal wall ends on the connection height itself, is there sufficient buccal bone to support the soft tissue later?

The PDL of the adjacent teeth will help keep the interproximal bone levels reasonably intact. The tough part is getting an impression and making an abutment. Neither of these parts can flare or they will impinge on the adjacent alveolus causing pain. If the impression coping flares, you will have to modify it into a straight profile the do the same with the abutment. Yo must use a custom abutment since the finish line will be heavily scalloped to follow the gingival contours. I agree with an earlier comment that an implant with platform switching would be advantageous since the abutment starts medially to the implant walls. This doesn't look like an Astra 3.0 so your implant may not have the built in platform switching concept.

More info on case - immediate placement, no flap/tissue raised. MIS seven implant used - has slight platform shift. 5mm transmucosal healing cap used (not all that transmucosal though). Additional questions 1. will I lose the interdental pappilla if I don't use a temp crown? 2. About this response - "I would like to answer you with a question,If the IP bone height is 5 mm above the implant abutment connection and the buccal wall ends on the connection height itself, is there sufficient buccal bone to support the soft tissue later?" I am not sure I understand the question - the soft tissue on the buccal is never as high as it is interproximally ie. the papilla?? Thanks Andrew

would a flapless mini implant better in this case?

Thank you for presenting an important consideration Dr. van Rooyen. Dr. H.: To begin with, the buccal plate is usually thin, blood supply limited, these by themselves, can affect your treatment modalities. Next, working with a central incisor places you right into the center of "esthetic zone." Therefore, it is imperative that you develope a "critical eye," if you want to keep your patients happy. It's true, resorption is minimal and negligible along your interproximal areas. However, translate this kind of resorption along the lines of your buccal aspect where your alveolar crest is in line with your implant head... What do you have? Your epithelial mucosa, being normally thin, may not be able to compensate with such shrinkage, thereby leaving you with an implant that is positioned supra- crestally[bu/li].Sure, you can install a good crown, but all the same, the quality of your restoration is affected. You may actually get away with it given that cervical areas along these perimiters don't usually show during conversational moments.The big question is: Will your patient be happy with it? Will you be happy with it? Warmest regards,

dEAR sHIRLEY, a mini sounds attractive but not a good option. Perhaps an UNO from MIS would be a nice choice.

Dear DR. Hughes, A mini was never presented as an option. I was simply helping Dr. H. with the art of projection. You've been working too hard, it'll do you good to take a nap. Warmest regards,

Do you think the implant head should be below the buccal alveolar crest? In fact it was by about 1- 1.5 mm. I posted the case as even as I did not want to distract readers from the question about the interdental "issue". Do you think 1-1.5mm below was too deep??? Can some one give advice on use of a temp crown to "save" the papilla. I though even without a temp, if the bone was ok, the papilla with "reform" once the crown is installed. or does this not happen, in which case a temp crown in needed to maintain them? Additional info - although buccal bone is thin, the space between the implant and buccal bone was grafted

Cordaropoli et al. 2003 Bone loss after 3 years found to be increased with increase in difference of vertical level of adjacent implants and with decrease in the inetrimplant distance, same relationships were not found between implant and adjacent tooth. btu if the implant is too close to the tooth, some bone loss may occur at teeth, if the patient phenotype is low scalloped with thick tissues, recession maybe minimal, if it is high scalloped with thin tissues more recession is expected. good luck Hamza

Dose the bone tissue grow faster or slower