Pt's implants were done overseas and abutments are small for molars. Very limited budget. I know we can use custom abutment or bigger size abutment to make the emergence profile better. However, can we just make small release incisions at the crown insert appt to get soft tissue to be adapted to the crown emergence profile?
7 Comments on Release incision for improved crown emergence profile?
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Greg Kammeyer, DDS, MS
Yes, releasing the tissue with a very limited incision makes it easier to insert the crown. However the base problem remains: I see manufactures making one size "fits all" abutments that are supposed to fit lower incisors AND molars. This is NOT good much less great dentistry. Remember when you put an implant in a patients mouth, generally they are shifting to "the best dentistry has to offer". The over contoured crown that results from an under contoured abutment will give the "tomato on a stick" profile, and leave the marginal tissue uncleanable, inflamed, receding and ultimately you'll have peri-implantitis. Explain that you prefer predictability and recommend changing the abutments.
wouldnt the tissue contact of a screwed down crown be cleansable and a full contour in contact with the tissue keep the interproximal spaces to a minimum and limit the amount of food pushed under the crown? If the incision is used to release the tissue the adaptation is going to be tight. Got to have karitinized connective tisue around the abutment.
Great question and one you will not likely get an appropriate answer to unless Matt Helm responds. Matt Helm knows everything there is to know about dentistry.... I know this is true because he says so!!!
I will attempt to weigh in on this though my response will not be worthy of inclusion in the Gospel of Matt Helm. I was trained to do custom cast abutments for every implant retained crown and then we started to see some adequate stock abutments emerge on the market. Today I believe most all custom abutments are milled and more common is the hybrid/screwmented version which is usually nothing more that a milled crown cemented to a Ti base. Yes making an incision will assist in proper adaptation assuming the problem is actually what you say and there is thick connective tissue. If however the issue is that the fixtures are placed too coronal without adequate depth for emergence then a booger on a stick is all your gonna get. I have gone round and round over the years trying to come up with a definitive response to the debate over the benefit of a custom abutment while the current trend back toward a screw retained restoration relies on the contour of the crown rather than the abutment for esthetic and functional emergence. Bottom line IMHO is that with a properly placed fixture in 3 dimensions stock vs. custom abutment vs. screw retained vs. screwmented will all produce acceptable outcomes but you can never go wrong with a well contoured custom milled abutment.... be careful though because I have seen some outfits mill a stick with a crown on it and produce a custom booger on a stick!!!
Richard Waghalter, DDS
Small incisions of the marginal gingiva or buccal mucosa usually do not heal back and a cleft in the tissues can develop from the lack of continuity. Have you ever noticed when you take an abutment and crown off an implant that it only takes 30 minutes for the marginal tissue to contract ,like an iris, and completely cover the implant? Around the implants you can irrigate subgingivally with fast-acting local anesthesia (Perioquix) which will numb the tissue rapidly for at least twenty minutes. This will give you time to place a primary cord with a larger cord on top to retract the tissue and prevent tissue from growing over the implant without having to make any incisions. This technique will prevent subginigval cement if placing cemented crowns. It will also prevent the tissues from blocking the correct seating of screw retained crowns. Also good for PVS impression taking. I don't feel that the smaller diameter molars create a problem unless they result in an edge-to edge cusp contact with the opposing tooth instead of cusp/fossa and edge-to-edge is a very hard type of occlusal contact to adjust adequately.
any other comments?