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Suggestions for a more predictable and aesthetic 2nd-stage technique?

Last Updated: Sep 26, 2017

I have a female patient with high aesthetic demands for whom I am replacing a single missing maxillary central incisor. Her tissue biotype is medium. I placed a 4.1x10mm Straumann BLT RC implant 3mm apical to the cervical margin of the adjacent central incisor. I marked the cervical margin on the adjacent central. I placed the implant, grafted, placed a cover screw and closed. The patient has returned after 4 months have passed, and I am treatment planning the second stage. My plan is to initially place a modifiable PEEK abutment, then place her in a screw retained temporary crown to assess gingival margins before definitive restoration. What are preferred methods for second stage surgery which leave an adequate thickness of gingiva labially? I often use a modified roll technique to bring some of the tissue covering the implant labially (a sort of poor man’s CT graft), but I find that I often see some diagonal scarring adjacent to the thickened gingiva at the joint. This has not worked well for some patients. Any suggestions for a more predictable and aesthetic 2nd stage technique?

4 Comments on Suggestions for a more predictable and aesthetic 2nd-stage technique?

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rsdds

9/26/2017

I like your placement You'll have nice papillas . I think you're in the right track soft tissue follows bone best. nice case thanks for sharing

kent hamilton

9/26/2017

do you have a photo before you flapped the area?

Vipul Shukla

9/26/2017

I think your worries are misplaced. Mid-crestal incision and then a well made provisional crown is fine. This case does not appear to be compromised. You seem to have a ton of keratinised tissue. Implant placement appears beautiful as well. Keep surgical site clean, use chlorhexidine for a rinse during the surgery and for a week after, smooth emergence profile of the PEEK abutment and the polished lab made (preferably) acrylic provisional crown and proper oral hygiene afterward will all go a long way towards a satisfactory result. A screw-retained crown is possible but will be unaesthetic. Wait 6 to 8 weeks for papillae to stabilize then make a polished Porcelain fused to zirconia cemented crown on an appropriate milled CARES zirconia abutment and then open a cold beer to celebrate. Cheers!

joe nolan

9/27/2017

If you can show a picture of the area at this time it could help ? Additive flowable to a screw in temporary abutment to bulk out the tissue is what I learned...George Priest shows this on a VivaLearning webinar....you then need a custom technique using silicon and a temporary abutment yet again, with the use of flowable to register the developed sulcus in order to get the emergence profile copied...are you aware of the technique?

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