Abutment Insertion Problems

Dr. L. asks:

I have difficulty inserting the abutment into the dental implant fixture. The gingival tissue grows tightly against the healing cap. I have to place releasing incisions at the distolingual and mesiolingual of the wound over the dental implant fixture platform in order to spread the tissue to insert the abutments.

I also usually have to core out the wound site with a #15 blade to gain space to insert the abutment. I have to do this for almost every case. I do not like having to do this. What can I do to eliminate this step? Any suggestions?

10 thoughts on “Abutment Insertion Problems

  1. Nick Dello Russo says:

    You may be countersinking your implants too deeply or placing the collar at or beneath the crestal bone. This was a problem with the old external hex Branemark implants. I would try not placing your implants too deep, assuming you have adequate interarch space, or simply attaching a healing abutment at the time of implant placement making it a one stage procedure. If you are very confident of your surgical skills you can try thinning the flap over the implant in non esthetic sites.

  2. Robert J. Miller says:

    Try using a diode of Er,Cr;YSGG laser to sculpt the emergence profile. You can do this without an anaesthetic, no bleeding, and no patient discomfort. In addition, it will not elicit an inflammatory response post-surgery that will result in the production of matrix metalloproteanases and ultimately crestal bone remodeling. You will be amazed at the results and you will manage your cases more quickly and efficiently.

  3. Greg Sawyer says:

    I use flared or custom healing abutments, mostly placed at the time the implant is placed, or placed at the rare stage 2 surgery. This prevents the tight tissue impeding impression copings or abutments.

  4. Chad in MO says:

    Great comments.
    Two different issues here.
    Incisions could possibly be due to the fact fibers actually do attach to titanium implant components? Contrary to popular belief.
    15 blade is a different story.
    Does the abutment have the same emergence profile as the final abutment? I would recommend using a healing abutment with an emergence profile at the 1st or 2nd stage (doesn’t matter) which emmulates the desired outcome of the final abutment. The depth of the implant should have little to no effect on the ability to restore a case properly. In fact you are able to create a more ideal emergence profile with an implant placed 2.5-3mm subgingival. You can still have your margin on the abutment .5-1.0mm subG to reduce cement and cleaning issues.
    Good luck.

  5. Dr.R. Mosery says:

    The healing abutment placed at the time of implant placement is usually the same diameter as the platform of the implant.If you’re using a countoured “esthetic” abutment you could find yourself pushing the tissue with out getting where you want to be. I routinely zip off all the esthetic contour and shoulder placed on these abutments giving me a flush finish from the implant to the abutment. this will work well regardless of anterior or posterior.You could compress the tissue slightly with your provisional to get the desired gingival effect.
    Good Luck.

  6. Dr. T. Linkevicius says:

    You should make plastic temporary crown on temporary or permanent abutment to form the soft tissue and keep it in place between visits. Without temporary you may have problems not only with healing abutments but also seating permanant restoration.

  7. Clark Brown says:

    It does sound like you are sinking your implants too deep or too close to adjacent teeth/implants. Manufacturers will give you a diagram or drawing of proper placement in relationship to the crest of the ridge. If you need to flatten the ridge at all, do so before implant placement rather than planning for crestal bone loss by counter-sinking the implant. Be sure to give yourself 2-3mm between adjacent teeth/implants. Placing them too close will impinge on the interdental papilla. I like the new Spectra system that Implants Direct now has. The abutment is also the carrier. This allows the dentist to physically see the final abutment placement. No guessing or estimating. Proper implant placement depth is assured as is placement with respect to adjacent teeth/implants. I think many placement problems can be solved with this system.

  8. Richard Clopton, DDS says:

    With the Nobel system I use over-sized healing abutments for almost all cases. These match the implant at the interface, then taper out to a larger diameter. You should use the impression transfer copings they make to match these abutments. I don’t know what platform you use, but this works with N/B.

  9. CYRIL CHEN says:


  10. dr.kiki says:

    sorry but its absolutely a wasted argument…just use t.c bur & remove as much as gingival tissue required to remove the healing abudment.. Dont be too liberal..tighten the abudment.. Call the patient in next 24hrs .. Un screw the abudment & remove the tissue tags.. Tighten it back on… Will look sooper..i promise..!!
    Best of luck kiki

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