Suggestions for a more predictable and aesthetic 2nd-stage technique?

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?

4 thoughts on “Suggestions for a more predictable and aesthetic 2nd-stage technique?

  1. rsdds says:

    I like your placement You’ll have nice papillas . I think you’re in the right track soft tissue follows bone best. nice case thanks for sharing

  2. Vipul Shukla says:

    I think your worries are misplaced. Mid-crestal incision and then a well made provisional crown is fine. This case does not appear to be compromised. You seem to have a ton of keratinised tissue. Implant placement appears beautiful as well. Keep surgical site clean, use chlorhexidine for a rinse during the surgery and for a week after, smooth emergence profile of the PEEK abutment and the polished lab made (preferably) acrylic provisional crown and proper oral hygiene afterward will all go a long way towards a satisfactory result. A screw-retained crown is possible but will be unaesthetic.
    Wait 6 to 8 weeks for papillae to stabilize then make a polished Porcelain fused to zirconia cemented crown on an appropriate milled CARES zirconia abutment and then open a cold beer to celebrate.
    Cheers!

  3. joe nolan says:

    If you can show a picture of the area at this time it could help ? Additive flowable to a screw in temporary abutment to bulk out the tissue is what I learned…George Priest shows this on a VivaLearning webinar….you then need a custom technique using silicon and a temporary abutment yet again, with the use of flowable to register the developed sulcus in order to get the emergence profile copied…are you aware of the technique?

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