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TomWhitdmd
Member Since: 01/25/12
Post: 6 of 28
What has she been wearing as a temp? To me it looks like #8 needed to be placed deeper.
Would be nice to see implants day of placement. Getting a papilla between two implants with
the defect she has would be extremely diffi cult if not impossible. As another poster stated, the
cantilever pontic would be a nice choice here but not with the placement of the #8 implant. I
don't think you have a ton of options, restoratively speaking, in this case, other than maybe adding
some pink porcelain on mesial #7, and have it inserted fi rst, and then placing #8 restoration.
Interested in other opinions also. ■
3/9/2022
DocHollidaze
Member Since: 11/28/18
Post: 7 of 28
She was wearing an Essix fabricated by the periodontist. I have to agree, I believe it needed
to be placed deeper. I am leaning toward the pink porcelain for the black triangle; however,
what are your thoughts about the visible collar and abutment? Dumb question: Can a gingivalcolored
abutment be milled or stained afterward? ■
3/9/2022
TomWhitdmd
Member Since: 01/25/12
Posts: 8 and 9 of 28
Visible collar and abutment are obviously a poor outcome, I would consider getting her out
of the Essix, having lab-made temp crowns fabricated and possibly eval how the tissue responds.
To me, just a little improvement in the tissue would be a big benefi t. Other option would be
discussing the practicality of another surgery to try to plump the tissue (that's out of my realm
of knowledge, so would have to hope the specialist is competent in this area).
I guess the nuclear option is remove and redo the implant, but that's the last option and I
would probably not bring it up unless patient is clearly unhappy and expecting better than what
the temps can accomplish. I've never done a pink staining on a zirc abutment but I believe it
could be done. Hopefully someone else will chime in on that.
So, here is a case I got back from the OS. Patient lost anterior retainer for bridge. That
implant on #19 looked terrible and obviously I was a little confused when she showed up looking
like this " ready to restore. " Anyway, there was a 1-2 mm of metal exposed on #19. I elected to
place lab temp crowns and follow up. The images are 18 months apart and within six weeks of
the temps being on, the once-exposed metal was covered by the gingiva. ■
3/9/2022
ljsdds
Member Since: 06/14/02
Post: 10 of 28
Patient might not care at all with low lip line. " Mrs. Jones, with the bone loss, the perio did
the best they could to even place implants. Life is a compromise, but you look beautiful when
you smile. "
This does get tricky with a diffi cult patient. At least you referred and this is a team effort
instead of you on an island.
I would send pictures to the periodontist and ask them what they think: Do nothing; free
gingival graft, which probably won't work; nuclear option (timely expression). All on the table. ■
3/10/2022
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