Tissue Impingement

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omsk

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Hi everyone

I am relatively new to implants and I have this case on my hands for practice. The issue I've come up with is this - I am trying to design a custom abutment and a cemented crown. The implant placement seems OK but maybe less than ideal. It seems there was no tissue management as the tissue around the implant is just as big as the implant.

I'd end up with a crown that looks like a lollipop if I were to just design an abutment without putting too much pressure on the gingiva.

In order to avoid this how far can I displace the tissue? Would there be any problems during sitting or long term if the displacement is too much?

I include some pictures

Thanks :)

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JMN

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Hi everyone

I am relatively new to implants and I have this case on my hands for practice. The issue I've come up with is this - I am trying to design a custom abutment and a cemented crown. The implant placement seems OK but maybe less than ideal. It seems there was no tissue management as the tissue around the implant is just as big as the implant.

I'd end up with a crown that looks like a lollipop if I were to just design an abutment without putting too much pressure on the gingiva.

In order to avoid this how far can I displace the tissue? Would there be any problems during sitting or long term if the displacement is too much?

I include some pictures

Thanks :)

4gxjdPQ.png


qBkyfSp.png
Vengg8j.png
bV7LQSi.png
Sorry that I can't give exact figures.
A little pressure and mild blanching is OK, your application of pressur over time will mold or model the tissue into a desired form.

Too mUch will cause pain/pinching. Way too much will remove blood supply and cause locslizsd tissue necrosis if undetected and untreated.
 
2thm8kr

2thm8kr

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Generally speaking, make the tissue conform to the abutment profile. Your current design of the bottom is similar to what I would design. Unless the tissue is keratinized it shouldn't be an issue. This is also something you should discuss with each client as they may have their own ideas of how the abutment should he designed.
 
zero_zero

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This is also something you should discuss with each client as they may have their own ideas of how the abutment should he designed.
That...I've heard various opinions about having 1.5mm impingement to barely touching so a floss could easily pass...

Use a harder soft tissue material what can be trimmed prior scanning...then adapt the emergence profile to that.
 
CatamountRob

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I've had accounts that didn't care how much I impinged upon the tissue, they wanted it to emerge as ideally as possible and the tissue would adapt. Others want no impingment, which creates major problems trying to make an implant crown look like a tooth emerging from the tissue. You sometimes wind up with a pumpkin on a post.
I'd ask how much impingement the doc is okay with.
 
Car 54

Car 54

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That...I've heard various opinions about having 1.5mm impingement to barely touching so a floss could easily pass...

Use a harder soft tissue material what can be trimmed prior scanning...then adapt the emergence profile to that.

That's what I do. I use an impression material, Imprint light body, which I could use a stiffer material,
but it's a little firmer than some of the soft tissue materials. I take a worn HS football diamond,
lightly remove some tissue all the way around, then design the abutment to lightly impinge and design the crown emergence from there.
 
EJADA

EJADA

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I’m in the make it look right camp. I use gingifast cad. Very trimable. Scans great. Most of my client will make a small cut on the mesial and distal interproximal gingiva if the Crown has to much pressure then when the crown is seated two quick tiny sutures. The gingva adapts beautifully from what they say.
 

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