Mucosa has completely covered over the implant: best way to correct this?

I installed an implant 6 months prior in a healthy patient.  The implant successfully osseointegrated and there were no complications. I placed a gingival former and healing continued uneventfully. The patient returned 1 month prior and I removed the gingival former to find that the mucosa had completely covered over the implant.  What is the best technique for correcting this?  I do not want to disturb the mucosa arond the implant as it has healed so well.  Is there a way to surgically correct this without compromising the mucosa?

9 thoughts on “Mucosa has completely covered over the implant: best way to correct this?

  1. Was the gingival former loose? How did the mucosa grow into it. You can trim the mucosa with a radio surgery needle tip to get the margin back. You can also use a molt curette to tease the tissue away front the implant. Is this an esthetic area? A dermal punch will also work.

  2. To correct the overgrown soft tissue (which hopefully should be keratinized gingiva and not mucosa) a tissue punch of the right size for the implant is simple and easy.
    If you have a waterlase, that is also a good way to remove the tissue.
    Make sure you take a post op radiograph after reinstalling the gingival former/healing abutment or the final abutment to make sure it is seated all the way since it is likely that this happened because it was not seated properly or got loose as CRS said.

  3. If you screwed in the correct way the gingival former there is no way the gingival or mucosa tissue grow between them.
    If the soft tissue covered and is over the gingival former you can use higher screws 3,4,5 mm.
    A radiograph would be useful to be sure the screw is seated ok.

  4. As Carlos and CRS stated or asked. Was the gingival former or healing collar lose? I use a coarse flamed shaped diamond bur in the high speed handpiece. I do not step on the rheostat. I simply run it around the inside of the platform and irrigate.

    I still to this day take PAs of anything placed on top of the platform. The exception is when I can visually confirm with my eye that the two are mated.

  5. Hi all,
    Simply insert a screwed in attachement for a bone mill, use the bone mill at 125 RPM and voila, all tissue removed!! Re-seat healing abutment and confirm proper seating and 4-6 weeks later impress as planned. Can happen to all of us but not big deal in the long term. I don’t recommend using hand held drill without a guide of some sort as you can score and damage the implant.

  6. When you say you placed a “gingival former” on the implant….I assume you mean a “healing collar”.

    Did you use the recommended parts that mate together? It is not unusual that a healing collar can become loose, and that tissue will grown between the healing collar and the opening of the implant….but the screw, if long enough will still hold the collar, although it will be loose.
    If the parts are properly mated…remove the healing collar, rub it with a disinfecting agent, rinse the implant ( go through the hole in the soft tissue with Dakins solution or Chlorhexidine, and rescrew the same healing collar….tightly. It would be wise to rub some topical anaesthetic over the gingival tissues before cleaning the implant and screwing it down….. in a day or so, the tissue will reform, and will not be sensitive.

    Gerry Rudick Montreal, Canada

  7. What your describeing sounds as if the implant is 4 mm or more below the gingiva.
    Sometimes this can be frustrating as the tissue seems to fall in or cover the implant.
    You may need to use a tissue punch ( with anesthesia) and than replace the tallest and perhaps widest healing collar that you can order. This should help and get the tissue ready for a final impression. IN ADDITION IF YOU CAN OBTAIN A SOFT TISSUE DIODE LASER THIS IS AN EXCELLENT INSTRUMENT TO TRIM TISSUE. It works better than electro surgery as it does not spark with the titanium and causes little to no post operative pain like a radiosurgery does.

    I hope this helps.

    David Furnari DDS, Scarsdale ,NY

  8. Unfortunately the tissue is going to grow back, assuming everything ( hard tissue ) stays the same. Make sure everything is clean and metal to metal and proceed. B Vinci

  9. One question,
    By removing the tissues with an electro-surgery unit, would this not affect the osteo-integrated implant? How close would one go to the implant with an electro-surge when removing soft tissues around the implant in the posted case?

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