As we all know, proper soft tissue healing is critical around dental implants. Not only must we achieve healthy tissue, but it is often vital to the success of the restoration that we achieve ideal soft tissue contour, volume and color around our dental implants.
Whenever possible, start planning how you will develop the soft tissue prior to the removal of the tooth involved and/or placement of the dental implant. The reason this step is so important is due to the fact that soft tissue changes are immediate following surgery; if we can start influencing these changes in our favor immediately after surgery, then we are more likely to achieve an ideal outcome. In this article, I will go over several options to consider when it comes to managing soft tissue for dental implant sites both before and after placement.
Options for Dental Implant Sites Before and After Placement
When it comes to developing sites where implant placement will be delayed, our best bet is to use an ovate pontic to help form the tissue at the dental implant site. This ovate pontic can be supported by either a fixed bridge – this could be a conventional fixed provisional bridge or a resin bonded provisional bridge – or an interim partial denture. In cases where it’s feasible, my preference, by far, is a fixed bridge since it provides constant influence on the tissue – unlike a removable appliance, which only provides influence when it is worn by the patient.
That being said, there are times when a fixed solution is not feasible and/or appropriate. A good example of when a fixed solution is not ideal is preparing teeth that would not need to be prepared except for this provisional phase. It’s worth noting that both of these options can also be used with your healing abutment or cover-screw – just be sure that the amount of load placed by the pontic on the dental implant is appropriate for the given situation.
In addition to the methods discussed above, we also have some other extremely beneficial options when it comes to influencing soft tissue healing around dental implants, particularly with cases in the esthetic zone. Those options are custom healing abutments and implant supported provisionals. The beauty of both of these is that they offer the ability to influence the soft tissue healing all the way from the top of the dental implant, rather than having a portion of the tissue generically influenced by a stock healing abutment.
If you are saying to yourself, great but how the heck do I make a custom healing abutment or implant supported provisional? Stay tuned – I will share some tips for that in my next article.
John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author http://www.johncarsondds.com