Soft tissue inflamed: Should I replace the crowns?

I agree

So these could be fixed with the more tulip shaped abutment to allow the soft tissue health. I do see the bone margins I am just unfamiliar with this system and since I don't restore I want to understand the emergence profile and esthetics. Thanks

The ankylos system has a classic platform shift and morse taper abutment connection. A true morse taper was in the original Straumann bone level implant as well as the original Astra.. No internal hex for orientation, just screw the abutment into the implant. A morse taper is an engineering joint where two mated surfaces at a 6 degree taper or less form a "cold weld" when torqued together. The Ankylos system is the same connection. This internal type of connection has minimal micromovement and virtually no microgap that leads to no bacterial percolation in and out of the microgap. This lack of micromovement and percolation keeps any inflammation away from the bone. With platform switching, if there is a zone of inflammation, it's onto the platform of the implant and does not extend laterally out to the crestal bone. It is generally acknowledged that the body needs .8mm (rounded to 1mm for me, a less precise type) of connective tissue between the inflammatory zone and the alveolus. The bone will either remodel from the microgap to form this cuff (bone loss) or the abutment can be more tulip shaped, more concave coming out of the implant not convex, to give space for soft tissue. A good article on the inflammatory zone and connective tissue cuff is by Ericsson I, et al. Clin Oral Impl Res 1996;7:20-26. I lecture a lot on implant engineering and am a big fan of the internal morse taper and platform switching to retain crestal bone. You probably have seen that nearly all implant companies are now selling some form of platform switching/shifting and an internal conical connection mimicking the morse taper

Excellent thank you for setting this humble oral surgeon straight with some valuable information that makes a lot of sense and ties up many principles I happen to stumble upon. Well said. Perhaps with my Zimmer, BioHorizons and Straumann crestal level placements I am avoiding the dieback problem. It is hard for me because I only see the patients return when there is a problem with the restorations and platforms. So I don't have a clear picture of what the ideal restoration and I am focusing on that since I can regenerate the bone and soft tissue at surgery, that's the easy part. If I can set the restoring doctor and patient up for success that's a "bingo!" Thanks Doc!

I couldn't agree more. Keeping bone is easier than replacing bone. The newer implant designs, i.e. roughened to the collar, morse (internal conical) connection, platform shifted and microthreads at the coronal aspect all work towards reducing damaging abutment micromovement and dissipate forces to the crestal bone that can lead to bone loss. It certainly helps us restorative guys maintain good soft tissue contours and profiles around our restorations when bone remodelling is minimal... and it makes our surgeons look good too!