A Dr., from Indiana, asks:
I recently placed a 4.3X13 Nobel Biocare Tapered Groovy implant into the #30 site at 6 months post socket preservation with Bio-Oss graft.
Upon flap elevation I noted that although ridge width was well maintained, there was minor vertical height loss (approx 2-3 mm dip below adjacent teeth CEJ’s). I placed the platform of the dental implant at this level.
My question is since the dental implant is somewhat deep (countersunk) in relation to adjacent teeth, the implant abutment connection will be about 5-6 mm below the free gingival margin. Any thoughts? Precautions? Should I consider reducing the gingival thickness?
Yes,consider reducing the gingival thickness, in the present state this is like a periodontal pocket.
Ideally this is all handled at the implant placement appointment assuming you are doing one stage surgeries, or at the uncovering if its a two stage procedure. In these cases of lower first molars we often see some vertical ridge change whether or not a socket preservation proedure has been done. In fact the socket graft is most useful for preserving ridge width.
When the implant is placed and the abutment is attached, you can thin and recontour the gingiva to fit snugly against the fixture and its healing abutment to result in minimum pocket depth when all is healed.
In the context of preserved socket with dynamic bone lose, like this case, what would be the best time for CBCT?
I will generally refer for the CBCT about 5 months following extraction and socket preservation with implant placement scheduled any time after 6 months healing.
Occasionally I will refer for the CBCT before the extraction if I feel there is information in the radiograph needed for treatment planning. The information in the pre extraction CBCT is still valuable for selecting implant size and it still provides info on nerve location, mandibular incline etc.