Implant restoration sitting on gum, like a pontic.

Adi

Adi

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Hi
I posted a few pictures of a molar implant which I made days ago,
and I got some comments telling me that it should not be sitting on the gum like a pontic do,

is that right?
if so, why not? what's the difference between it and a pontic?

here's the pictures, some of it are blur, sorry: E.jpg F.jpg I1.jpg I2.jpg A.jpg C.jpg 11.jpg 13.jpg 14.jpg 15.jpg
 
2thm8kr

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If the crown is sitting on the gingiva like a pontic, how is the dentist going to remove excess cement from under the crown?
Cement sepsis is one of the causes for implantitis and failure of implants.
Make the tissue conform to the design of your restoration. I.e. as natural of a contour as possible from the margin toward the occlusal surface.
 
Marcusthegladiator CDT

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Its not hygenic for the patient either. Colonies of gross stuff are going to fornicate under there...
 
Marcusthegladiator CDT

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You're crown looks nice though. :) If i could change anything, it would be nicer models and no more tab off buttons. Especially on the lingual of a lower posterior. Again, youre crown does look nice...
 
Affinity

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I always choose hygiene over esthetics with implants.. having said that, some docs want them to look like this.. If done correctly, it is possible, but even with a pontic, it needs to be ovate.. convex. No concavities or hiding spots for bacteria/cement.
 
Jo Chen

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Nice crown, I like how you made it bifurcated.
Implant restorations have to be a little different than natural teeth. Keep the occlusal table narrow and no ridge lap or Pontic shape. Cement left behind is a implant killer and the ridge lap makes it very difficult to clean the cement out and the patient will have a hard time to keep that clean as is on a daily basis
 
dmonwaxa

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This is what happens when the soft tissue is not shaped adequately prior to the final restoration. The docs should have considered this, unless the hard and soft tissues dictated otherwise because of the location of the nerve. If placement was deeper it would have allowed for a better emergence profile but the cement at margin would be deeper, sub gingival in the tissue. Not good either way long term. If you were to roll the buccal at the cervical 1/3 it would be more hygienic, but crappy looking.
 
CoolHandLuke

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congratulations on attaching the picture.
 
Marcusthegladiator CDT

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Adi, thanks for sharing your crown and photos. Keep it up.
 
Adi

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Thanks to you all for your time and for sharing information.
I got the picture now, next time I'll play right.
 
cadfan

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The patients pay a lot of money for surgical an so on a molar like this must have and individual abutment with a larger circumference ill make them with zi hybrid and push the gingiva so the diameter is not 5 mm its more 7-8 with a real profile 0.5 subgingival so you can clean the cementation an you dont have concave part witch cannot be cleaned by doc or patient 11.jpg I11.jpg
 
dmonwaxa

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The patients pay a lot of money for surgical an so on a molar like this must have and individual abutment with a larger circumference ill make them with zi hybrid and push the gingiva so the diameter is not 5 mm its more 7-8 with a real profile 0.5 subgingival so you can clean the cementation an you dont have concave part witch cannot be cleaned by doc or patient View attachment 15916 View attachment 15917

So, is this the lab's fault, some perhaps but not really. It's been my experience its due to lack of proper planning and or lack of communication not excluding the greed, frugality or ignorance clinician (s). From experience most implants are placed less than ideal from a restorative standpoint, that is usually because "that's where the bone is" ( placed haphazardly = DGAS). This particular case is not like those mentioned in that respect, the distal placement next to the adjacent teeth is fine, but the vertical placement and the top of the implant is more than likely whats limiting a more natural emergence profile. This is probably due to the vertical height of the available bone while avoiding the nerve as mentioned before (cant say for sure). Using the tallest implant may have provided the stability for the restoration but not necessarily contributing to making it esthetic or hygienic. The ideal would have been to make a custom abutment to displace the tissue and also provide the ideal placement of the margin for cement cleaning; cant tell from the photos, looks like a modified stock abutment, could be wrong.

Nice job on esthetics Adi, but always as been mentioned a few times before, choose function and hygiene over esthetics, refer to cadfan's modified image.
 
CoolHandLuke

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Thanks to you all for your time and for sharing information.
I got the picture now, next time I'll play right.
best of luck Adi. we wish you well. its nice to see someone who is able to take new information and use it instead of puff their chest.
 
lcmlabforum

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Welcome, you obviously have great hand skills and can create good work, just need
to marry that with what would be beneficial clinically to the patient and your potential
can be leveraged to a fuller extent.
Dentistry is both an art and a science, not one without the other.
Cheers!
LCM
 
victormasi

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There are times when you have no choice but to overlap the soft tissue to get the correct esthetics.
An option is to add a second implant mesial to the existing one. What we do is a 2 part/screw retained restoration. You make the abutment, then the PFM with an access occlusal hole. When the clinician cements the two at chairside, he can then unscrew the entire "stack" and polish off the excess cement. It still is a hygienic issue for the patient but you at least eliminate the cement problem'. Waterpik the sucker on a
daily basis.
 
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2thm8kr

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I'll stick to the old term "Form follows Function.,"
 
dmonwaxa

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There are times when you have no choice but to overlap the soft tissue to get the correct esthetics.
An option is to add a second implant mesial to the existing one. What we do is a 2 part/screw retained restoration. You make the abutment, then the PFM with an access occlusal hole. When the clinician cements the two at chairside, he can then unscrew the entire "stack" and polish off the excess cement. It still is a hygienic issue for the patient .but you at least eliminate the cement problem'. Waterpik the sucker on a
daily basis.


Why add cement to the equation, why not just make a screw retained crown?
 
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