When and how to correct peri implant gingiva?

Patient presented with ill-fitting existing maxillary RPD supported by 4 teeth. Remaining maxillary teeth were deemed hopeless. Treatment plan: placement of 4 implants with adequate A/P spread followed by extraction of remaining teeth following complete osseointegration of implants and fabrication of a complete overdenture with Locator attachments. Full thickness flaps were laid and implants were placed all with primary stability over 45Ncm. Healing abutments were placed on all implants and surgical areas sutured. RPD was relined with soft liner ensuring surgical areas were relieved accordingly. Roughly 2 weeks have passed since the surgery. Sutures have been removed. Patient has not experienced any pain or discomfort. Clinical exam revealed though that the peri-implant soft tissue around the posterior implants have a concavity due to what appears to be from mechanical trauma during function of the RPD. There is no implant platform exposure. Soft tissue is approximately 2-3mm in thickness. When and how would be the best approach to correcting the peri-implant soft tissue?

2 thoughts on: When and how to correct peri implant gingiva?

  1. Matt Helm DDS says:

    The short answer to your question is yesterday! You have probably not relieved the PUD sufficiently in the implant areas, allowing it to traumatize the tissue. Your other mistake was in not burying the implants and instead placing healing caps from the beginning. Had you completely buried those implants you would not have this problem! What’s the hurry? Placing healing caps at the time of implant placement in a case like this does not in any way slow down your treatment plan. Lastly, you should have relined the PUD with a soft reliner.
    You may also need to properly instruct your patient in proper oral hygiene and ensure they follow through with it.

  2. kathe c says:

    I am a patient, and I had 5 implants in my mandible just a week ago, after bone leveling because of prior bone loss from tooth loss from when I was a kid. There are stitches still, for another week. The problem is, the ‘soft reline’ is soft enough, but it completely fills the concavity of the temporary removable denture, and actually spills out over it! To the point that it makes my lower lip pooch out too far. It seems like there is about a 1/4 inch of the stuff between my gum and the front part of the denture, and when I look at it, it looks like the circular impression from where the implant’s are touching the reline material, is on the very edge of the back of the arch of the denture. i know i don’t know all the right words, I’m sorry. I noticed when my dentist was getting ready to place it the first time, The reline stuff was level, and they told me to bite down and don’t talk or eat for three hours. And the next day, when he took it out to check it, it was all puffy, and it just seems like there is too much of it. he looked at it, said, huh, kind of hesitated, rinsed it, and put it back in. Did he notice there was too much of that stuff? but didn’t have time to fix it? I don’t go back for another week. The gum tissue looks fine and healthy, as far as i can tell, and doesn’t look red or infected. but there are many parts of my mouth that aren’t anywhere near the stitches or implants that are getting scraped by the denture moving. When i told him that it seems to be just floating around in my mouth, he said welcome to the world of lower dentures! And that was all. The only relief I get from pain is when I take them out at night. Is there too much reline material? Please help!

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