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Final impression after immediate dental implants placed too deep: options?

Last Updated: Feb 25, 2020

I extracted molar tooth #3 instead of planned tooth #2. I placed an implant 3wks after using L-PRF/DFDBA. Two months later, the patient still needed attention to #2. I extracted it and placed an additional implant, lifting sinus and filling with some sticky bone. I staged both surgeries as a one-stage procedure. Patient presented yesterday for final impressions. However I was informed by the office that soft tissue was covering the healing caps. My intentions were to replace with a larger sized healing cap and take the final impression. As noted, I placed the implants a little too deep so could not place larger sized healing caps. I intend to see the pt again in 4wks. However I am undecided on how to proceed. My options are to do a mid-crestal incision, with an oblique release mesial to tooth #4 to conservatively advance the flap to profile bone to fit a larger sized healing cap, wait another 4-6wks and then take the final impressions, or to use UCLA Abutments. Thoughts/critiques welcome.
Thank you for your time.

4 Comments on Final impression after immediate dental implants placed too deep: options?

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Joseph Kim, DDS, JD

2/25/2020

Depending on the brand of implant, you can use a bone profiler to cut the supra-platform bone at a 45 degree angle, allowing wider components to be placed/used. If a bone profiler is not available for this system, then simply place a cover screw into the implant and use a round diamond bur with sterile irrigation to create a bevel in the bone around the platform. Alternatively, you can place provisional screw retained restorations that are heavily concave near the platform, until the body remodels the platform area naturally. In the future, until your free hand skills improve, consider using a guided surgery approach to achieve optimal angulation, vertical and horizontal position, and interimplant spacing. Hope this helps.

Dr Dale Gerke, BDS, BScDe

2/25/2020

Joseph has outlined exactly your two best options. I would like to see a better radiograph of the sinus. One view you showed concerns me a little that your sinus lift might need a little more attention? The other concern is that you mention “I was informed by the office”. Have you actually seen this patient post op?

Timothy Carter

2/25/2020

Just remove the healing abutment and place a cover screw to protect the top of the fixture. access the area and use a #8 high speed carbide to remove/profile the coronal bone and proceed with final impression. This is really no big deal.

Doctorberg

2/25/2020

What was outlined in the posts before is ok, I have just a comment. When you are too deep you need to get away from the bone-implant-abutment zone. Use a concave abutment that gives you an abutment level impression, not a fixture level one. Multi units are made for this in a one abutment one time sort of protocol. Bone heals around them as the implant integrates and you get good aesthetics and proven long lasting results avoiding inflammation and pain. Cheers

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