Implant Above Tissue: Prep the Margin on Implant Itself?

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Dr. S, asks:

My patient had implants placed in the area’s of #7 and #10 for a bridge #7-8-9-10. Due to the shallow placement of #10 I have found that the margin of the Astra Implant is above the tissue. Esthetically this is unacceptable. I am wondering if anyone has ever actually prepped the margin on the implant itself?

Currently this type of dental implant and abutment (Astra) appears to have a double margin due to the real margin on the abutment (which is above tissue level) and where the abutment is inserted to the implant. I am looking for the least invasive way to correct this issue. I would rather not have to send this patient back to the oral surgeon if I can just slightly prep a light margin on the implant itself. The implant is showing and no bone removal would be necessary to prep.

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5 Responses to “ Implant Above Tissue: Prep the Margin on Implant Itself? ”

• Dr. A September 25th, 2007

  
  

  I have prepped many implants to lower the margin. Torque your abutment, use sharp new burs, go slow, copious irrigation. Treat this like a tooth. The hardness of the implant is determined by the grade of the Implants Titanium. Titanium Alloy is much harder that Grade four commercially pure or grade three which is relatively soft. Remember that any of the fancy impression components that Astra may sell you will not work. This is now a tooth and a direct impression of the implant and abutment is how you are treating this. Pack cord into the sulcus as you do not want to tattoo the gingiva with metal shavings from the Implant.

  Also make a preop impression to show your surgeon. Constructive critisism should be appreciated.

  Best of luck.

• Sinjin September 26th, 2007

  
  

  Sounds to me if the implant is at the bone level, remove the abutment, put on an impression post, open tray fixture level impression and send off to the lab for a custom abutment, and best for this case a screw retained. Since astra doesn’t really have any collar to prep, this would be the best option

• anonymous September 26th, 2007

  
  

  Dr. A,

  Is it the implant above the tissue or is it the abutment? What do you mean by a “double-margin”? Astra’s implant has a bevel at the top, and then the abutment emerges from the implant. Then you have a modular machined collar as a part of the abutment before the restorative margin of an abutment. If it’s on the abutment, you could either prep it, or impression the implant and exchange for an abutment with a subgingival abutment. If you don’t know, I would recommend you have a conversation with you Surgeon.

• ira dickerman, cdt October 19th, 2007

  
  

  I would suggest getting a reject implant from Astra and an abutment. Take an implant level impression pour the cast with the reject implant and prep the abutment on the cast. Due to the profile of the Astra Implant / Abutment Interface it may be difficult to prep a correct margin that will seal with the casting. The Astra abutments are expand to a wider profile than the top of the fixture. You need to utilize the smallest diameter abutment available and prep all of the outer dimension off. You might be better off having a dental laboraotry with milling capabilities do this for you.
  After the abutment is placed and torqued intraorally you will need to prep the implant to match the prepped profile as the implant in the cast.

  You and your patient should understand that this will violate the premise of the bone level maintenance with this system, and that is the trade off neccesary for esthetics.

• Ron Neff March 31st, 2008

  
  

  Go ahead and prep the implant once the abutment is firmly affixed, I have done this many times. Keep cool. Take care to avoid allowing shavings into any open capillaries, as tatooing will result. This can be done with a wide cord or a retraction instument. I usually finish with a custom tipped white stone. Take an impression and return to the lab for a PFG. Cement or lute, marginal seal is forgiving compared to organic tissue situations.

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Wed August 20 2008

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