Mind the Gap-Soft Tissue Loss around 8/9 implants

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Posted on By Matthew Giulianelli In Implants

This is a 38 y/o male, no medical contraindications. He came to us this morning for a second opinion on what can be done for the loss of the interdental papilla between 8 and 9. According to him, he had bone grafting after trauma, and implants were placed 2013.Space has developed in the past few years. He wants to know what can be done. His smile line stops right at the apical of the contact point between 8 and 9. IHB to contact area is about 5mm.
Some options that come to mind
1) Autogenous CTG first, then possibly some veneer bone grafting around 8 and 9.
2) Remove prosthesis, place cover screws on 7,8,9 and use nature's soft tissue graft first by letting
gingiva close, then use "guided" tissue regeneration with narrow healing abutments on 7,8,9 with a soft tissue graft, have patient in essix appliance.
3) Do nothing

Anything obvious I might be overlooking? Other options come to mind? Thanks

In occlusion

8 sagittal

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My initial thoughts are that the crowns just don't look right and a simple solution might be to remove all and bury the ur1 implant with soft tissue graft and bridge from ur2 -ul1 temporaliy 3 months, then with good lab tech you'll get a more pleasing end result that might not be perfect but a great improvement
It really depends upon what the patient wants and expects and the journey the patient may wish to travel and the economic reality


Barry, great thought and perspective, thanks


Your most predictable bet may be prosthetic gingiva. Shade matching can be tough but there are labs out there that can make it look nice. Making the teeth more anatomically correct and adding the gingiva in restorative material may be more predictable to do than trying to augment this with soft tissue grafts (which may make things worse if it is not flawless).


Jonathan, absolutely. I realized after posting that this is an option, probably the easiest and most predictable. I never have had good luck matching gingival shades. Is there a shade guide you recommend or a lab you know that does a great job with pink porcelain?


Anaxdent by Christian Coachman is an excellent prosthetic gingival material. Tough case...one of the reasons why not to place adjacent implants in esthetic zone. "GSA" gioded soft tissue augmentation and sleeping middle implant is an option as well but you will still have long contacts. Good luck. Dr. Salama


What is the smileline of this patient? If the patient is not showing the blacktriangle, why bother? And if it is a subjective esthetic matter, then I would indeed look for a better ceramist who can make the toothform and proportions in a natural way, with a pink porcelain papilla.


Henry Schein