Gingival recession after change from temporary to real abutment?

I have a patient where there was considerable gingival recession in the maxillary anterior aesthetic zone.  I had previously placed a temporary abutment and temporary acrylic crown and the gingiva was stable.  But shortly after I placed the permanent abutment and permanent ceramic crown, the gingiva receded to where it is in the photographs.   What can I do to reverse the gingival recession and return the gingiva to its prior state where it was comparable to the adjacent teeth?  I need to make this correction within one month due to my schedule. Thanks for any comments.

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8 thoughts on “Gingival recession after change from temporary to real abutment?

  1. The final abutment has too much emergence. I think your temporary abutment must’ve had a nice under contoured emergence profile based on how your soft tissue looked in the temporary state. That was a beautiful gingival architecture you created for the impression. How long was the patient in a temporary? I would recommend getting the patient back into the temporary, polish it up again and let the soft tissue stabilize again. The reason I wouldn’t adjust the current abutment is because it appears to be zirconia and I wouldn’t want to create a rough surface around the gingival margin that bacteria and plaque can adhere to. I would request the lab flatten that facial contour too.

  2. I see you have done a roll flap at point of exposure. I think the gingiva is too instable to adjust to any size bigger than the temp abutment and crown. I also think that the gingiva won’t come back to the previous shape, even if you place the temp back. I think you need to start from healing screw again.

    1. Can you say what a roll flap is please? I’d have felt that the abutment is much too thick also..you can use this technique to profile gingiva of course…but only in the temporary phase

  3. I agree with Dr.Patrick in a sense that the size difference of emergence profile between the temp and the final crown is the chief cause ,I believe that gingival fibres are under pressure( stretched) by the over contoured crown and adding the brushing force to an already underpressed fibres
    render recession .however, I don’t agree that the rough surface could play a role here since the crown should be smoother than a temp.
    My suggestion is to get back to the same temp and PRAY that soft tissue
    reacts as you wish in one month, then ask your lab to fabricate a final prosthesis with better emergence profile and a flattened labial contour. Good luck , kindly please share with us the outcome of this case. Thanks

  4. If you and the patient where happy with the temporary, and that is your expectation, you need to remove the definitive crown and go back to the temp. Evaluate the gingival tissues over time. If the soft tissue has a good response wonderful! If you are not happy with the presentation because the temporary does not exhibit the same presentation as before you will need to do a revision (while in the temporary)until you have a desired result. This might require soft tissue grafting and it may take considerable time. Once you and the patient are happy with the presentation you will benefit by providing a master cast to your lab which reflects the existing sub-gingival contours. There are very consistent techniques to provide this information in the master cast. If you are happy with the soft tissues in the provisional phase you can be confident in the proposed emergence profile of your definitive restoration only if your lab has an accurate soft tissue analog.
    Unfortunately, like the weather mother nature doesn’t care about your schedule. The outcome of this case will be dependent on your knowledge base and skills and the healing potential of your patient and time. By the way, if the blanching on the facial cervical soft tissue zenith of this central does not pink up within about 3 minutes the emergence profile is to great and needs to be adjusted accordingly until the soft tissue no longer blanches. You will get recession of those tissues due to lack of blood supply. Hope this input helps.

    1. Dear Fredrick Shaw, have you bibliografy references for the time of reblaching on the cervical soft tisuue?
      Thank
      Mauro Carteri

      1. Go to pub med.com look up evaluation of blanching of gingival tissues around dental implants. There are tons of referred journals on that topic.
        Respectfully,
        Fredrick Shaw DDS ( Diplomate of the American Academy of Prosthodontics).

  5. First of all i would like to point that at the stage of planing implant you should have consider a frenectomy at first,cause mainly it’s the source of tension which gives collapsing in soft tissue after.
    Right now i would consider a CTG graft if no dehiseance yet.

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