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Metal Abutment Exposed on Implant: What Are The Best Options?

posted in Abutments, Treatment Planning & Complications, advice

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I have a patient with #9 [maxillary left central incisor] replaced by an implant and a metal abutment and PFM. The gingival has receded slightly and the metal abutment is showing. Also there has been a graying of the gingival tissue on the labial of the implant. I am considering options. If I replace the metal abutment with a ceramic abutment and do a ceramic crown should this solve the problem? Do we have to explants, graft and replace the implant?

5 Responses to “ Metal Abutment Exposed on Implant: What Are The Best Options? ”

• Bassam Kinaia April 28th, 2009

  
  

  Generally for implant body/abutment exposure, it is necessary to evaluate the periodontal tissue to see if it is thin or thick biotype before the procedure to avoid the current situation.
  Moreover beside the dark hue showing, the free gingival margin symmetry in relation to the smile line need to be evalauted for better esthetic results not only for #9 implant but for the anterior maxillary dentition. Therefore, based on your description (and depending on the bone level interproximal to the implant of course) a connective tissue graft may help to reduce the dark hue showing by increasing the gingival thickness bucco-lingually. Therefter, the maxillary anteriors can be re-evaluated for new zirconia abutment or esthetic crown lengthening depending on the evaluation.

  Good luck

• Robert56 April 28th, 2009

  
  

  It really depends on the type of implant.
  Some systems have ceramic stock abutments and some need a CAD CAM abutment. It is really important to choose the system that has the abutemt options to hide this problem. Some systems have a very poor tollorance and some are tighter. The longevity may depend on the bite conditions. As far as the implant showing, the Zirconia implants that are currently out are generally one piece implants and there is a new two piece zirconia coming from Thommen Medical this summeras well as some of the others in the end of the year.
  The core tooloing can be gottem from each company specific to that company but Salvin can provide cores at really good proces. After all i t is just a drill blade.
  Doing a graft has been traditionally the option up to this point but has been less than effective in many cases and has only been hiding the real issue of poor placment and health condition sthat arise after placement as well as choosing a system that is less than ideal for its indication.
  Long winded but hope this helps

• Don Callan April 29th, 2009

  
  

  The facial bone is thin in this area. There may be more recession to come. It may be best to replace the implant, regenerate the the bone and then the place another implant more toward the palate, if possible.

• steve c April 29th, 2009

  
  

  If the labial gingiva is healthy and the probing depth minimal and if everything else with the implant and surrounding dentition is acceptable, then I would place a subepithelial CT graft to thicken overlying tissue (thereby minimizing grey shine through) and cover the exposed metal abutment. Then I would make a decision about a Zirconia abutment. Removing the implant, grafting bone and placing a new implant in the hope that it will solve all problems is a very involved, complicated and sometimes unpredictable process which can be very hard on the patient.

• Dr shahab May 1st, 2009

  
  

  Hi doctor
  you can make a crown with shoulder porcelain design.
  in thise design we extend porcelain over exposed metal in labial .

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