[Prosthetics]  creating new emergance profile for implant molar

patient presents this week complaining of #46 implant crown, recently placed at another office. is has never felt comfortable and she is constantly having to floss under crown.  i think the situation can be improved if crown and abutment (it is cemented crown, and has been off a few times) are removed, and a custom one piece screw retained  abutment crown is placed. i think the situation can be improved with a better emergance profile.  implant is 5x10 mm tapered groovey.  comments?

by Terry Grover at Thu, Aug 2, 2012 10:05 PM

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Mark Kwon Replied at Mon, Aug 6, 2012 4:14 PM

Great comments! If i would add one more thing, May want to check the draw of adjscent procimal walls. May want to do minor enamelopladty or "crowno-plasty" to achieve better draw and reduce the triangle food trapping further. Ps. Im taking everyones advise... Im on vacation w family in yellowstone. Im lUvin it ^^*

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Bernard Jin Replied at Fri, Aug 3, 2012 3:48 PM

Thanks Albert for your input. Yes - I truly appreciated your comment about the soft tissue "gasket" effect. Also, the application of the PRF this way is a wonderful idea! Thank you for sharing :)

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Bernard Jin Replied at Thu, Aug 2, 2012 10:44 PM

Hi Terry, Great case. Great question. I would look athe soft tissue 1st. Do you have any photos? The point of the patient not feeling comfortable can stem from: - possible cement trapped in the gingival tissues - food impaction around the implant (bucco-lingually) or embrasure spaces I would look at the soft tissue to see if there is plenty of soft tissue biotype or not. If there is, then removal of the crown + abutment would help identify the cause. Then fabricating a screw-retained fixture level prosthesis would help perform tissue compression and possibly a favorable emergence profile. Alternatively, if the soft tissue is flat and the neck of the implant sticks out of the gingiva, then the problem could very well be a implant placement issue whereby the implant was not placed deep enough (or the bone around the implant has deminished). If it happens to be this - then the solution may be difficult. As in very difficult to solve - because the soft tissue architecture itself presents a negative environment that traps food easily. Soft tissue grafting (overlay) may help or make things worse. Or at extreme cases - an explant and reimplantation deeper (or use a shorter implant). Hope that helps. :)