Dr. K. asks:
I am restoring #8, 9 [maxillary right and left central incisors] in a middle age female patient in excellent health and with the rest of her dentition intact. I placed the implant fixtures too far subgingivally so that the top of the implant platform is 4mm cervical to the adjacent cervical margins. Is this really a problem? I have not done that many implant cases and I have not encountered this problem. Should I just go ahead and restore the case as is with custom abutments and cement retained porcelain fused to metal crowns?
Submerged Implant Fixture: Is this a Problem?
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We try to shoot for 2.5-3mm below the intended FGM- 4mm is a bit more than that, but should not be an issue. Where it can be an issue is if the implant fixture that was placed was not a bone level implant. In that case you may have more remodeling than you would like. If it was a bone level implant, then go ahead and have a custom abutment made and keep your cement line about .5-1mm subgingivally.
You can restore but you probably going to have a perio problem with a deep pocket.
the following information is important in determining possible outcome:
Type of implant-abutment interface
1) type of implant
2) diameter of implant
3) amount of inter-implant bone
4) Type of bone
5) Soft tissue bio-type
6) bucco-lingual position and trajectory
7) Thickness of gingiva
9) Restorative plan
Please share these information to help provide insight as to potential outcomes.
Thanks
Actually you will be fine, just stick to zirconia abutments and it would be better if you get the crowns in one piece, not cemented, just ceram over the abutment and keep a long contact interproximal area so you can keep the gingiva in place.at the time of placemnet use the technique described by Hebel so you wont over compress the gingiva. That should get you home free.
If the implant fixtures are at or above the bone crest then they will be fine. Otherwise, it’s the matter whether you want to grind down the surrounding bone to the fixtures level or let the bone remodeling process procceeds itself. In the latter case, patient will experience chronic gum inflamation, advancing pocket depth, possibly occasional perio abscess, and eventually the gum recession after the bone remodeling completes itself which may take years. However, if you decide to go ahead and grind down the crestal bone to the fixtures level in the anterior area instead, think of a possible aesthetic compromise if the patient also has a high lip smile.
In this case, esthetics would be of paramount importance.Complications which could follow, like periodontal pockets et al would advocate a repeat procedure to correct the implant position very worthwhile so that esthetics would not be compromised.I guess on the long run, this would be comfortable for both, the Dentist, as well as the patient.
To add to Ryan’s list ,the lip line and the width of attached gingiva are factors that could influence treatment outcome.A 4mm deep sulcus is bound to be troublesome sooner than later.If the lip allows and you have adequate attached tissue,you may consider surgical reduction of the sulcus depth prior to restoration
I do agree with Dr.Alejandro Berg It would be advisable to use screw retained pre cemented prosthesis ..dr sameer bhandari
i would extract the implant if not yet integrated and place another 4mm longer.