Best way to handle supragingival margins on abutments

[Brett Hansen CDT]

I get cases from time to time where the implant isn't placed deep enough under the tissue. This results in an abutment margin that is supragingival. On certain implants, where there the abutment comes all the way out to the edge of the implant, you can drop the material down past the interface of the abutment and the implant to solve the problem. This is much trickier on implants like Astra or Straumman's bone level implant. I feel like the best way to handle this is to design the crown in a "highwater" style, especially if the restoration is in the mandible. If I design the restoration to come down past the margin of the abutment to touch the tissue, then there will be a gap between the crown and the implant that will be hard to clean and could trap food. I figure it would be easier for the patient to clean if the crown is designed more like the attached pics. What are your thoughts?

 

[rkm rdt]

Synoctas need a redesign for the digital world.
I get this all the time. Consider it similar to a pfm with a metal collar.

 

[Sevan P]

Fix the neck area to be more smoother and leave it for cleaning purposes.

Of do a ridgelap and make it look normal but screw the PT per the doctor's order.

I would call and have the doctor make the decision.

Sent from my SM-G920V using Tapatalk

 

[lcmlabforum]

If this is the posterior teeth, pt should not bother. Not that they won't but realistically,
the biologic principles of cleansability should tr*mp esthetics at posterior areas.
The synOcta was not the original intent of placing Tissue Level implants, Straumann
implants were originally designed to have platform at or above the marginal gingiva.
That was the understanding but I could be wrong, getting old . . .
Cory, do chime in.
LCM

 

[JMN]

I get cases from time to time where the implant isn't placed deep enough under the tissue. This results in an abutment margin that is supragingival. On certain implants, where there the abutment comes all the way out to the edge of the implant, you can drop the material down past the interface of the abutment and the implant to solve the problem. This is much trickier on implants like Astra or Straumman's bone level implant. I feel like the best way to handle this is to design the crown in a "highwater" style, especially if the restoration is in the mandible. If I design the restoration to come down past the margin of the abutment to touch the tissue, then there will be a gap between the crown and the implant that will be hard to clean and could trap food. I figure it would be easier for the patient to clean if the crown is designed more like the attached pics. What are your thoughts?

My thinking is that the way it is shown is a food trap. One they will likely not clean with any regularity. lly they would floss daily and under the crown too. I don't even floss daily and it's doubtful that many patients do with any alacrity. Without knowing the DDS his/her 'style' it's hard to guess. Call them, email the pic, and see.

If you can't get any response and it's possible in the digital world, closing the hole would be my path.
Could be wrong again, but that's the way I'd always treated that problem in the good ole analog days.

 

[CoolHandLuke]

whatever you do have the doc sign off on it so if it comes back its not a free remake.

 

[Brett Hansen CDT]

Doc signed off on my design. Thanks for all the input!

 

[JMN]

Doc signed off on my design. Thanks for all the input!

Glad you could get a sign-off!

 

[TheLabGuy]

Glad you could get a sign-off!

Amen...so happy you sent that picture to your Doc Brett, this case handcuffed you before you even got started. I've a few cases like this myself, the only option you could of done is created a ridge lap...but the cleaning and the possibility of the implant going dehissent is the drawback.

 

[JohnWilson]

If this is the posterior teeth, pt should not bother. Not that they won't but realistically,
the biologic principles of cleansability should tr*mp esthetics at posterior areas.
The synOcta was not the original intent of placing Tissue Level implants, Straumann
implants were originally designed to have platform at or above the marginal gingiva.
That was the understanding but I could be wrong, getting old . . .
Cory, do chime in.
LCM

You and I are getting old but you are not the least bit wrong