I have a female patient with high aesthetic demands for whom I am replacing a single missing maxillary central incisor. Her tissue biotype is medium. I placed a 4.1x10mm Straumann BLT RC implant 3mm apical to the cervical margin of the adjacent central incisor. I marked the cervical margin on the adjacent central. I placed the implant, grafted, placed a cover screw and closed. The patient has returned after 4 months have passed, and I am treatment planning the second stage. My plan is to initially place a modifiable PEEK abutment, then place her in a screw retained temporary crown to assess gingival margins before definitive restoration. What are preferred methods for second stage surgery which leave an adequate thickness of gingiva labially? I often use a modified roll technique to bring some of the tissue covering the implant labially (a sort of poor man’s CT graft), but I find that I often see some diagonal scarring adjacent to the thickened gingiva at the joint. This has not worked well for some patients. Any suggestions for a more predictable and aesthetic 2nd stage technique?
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