Papillary fill at delayed loading protocol

119 Rating(s).


Posted on By snjezana pohl In Implants

In my clinic I am famous as a fighter against artificial pink. In many cases it is inevitable, but I could show you a dozen of cases where the natural gum is squeezed and pushed in order to make place for artificial pink.
In this particular case I fought for papillae space, especially right lateral incisor/canine papilla.
Patient had provisional for 4 months, papilla haven`t developed. Patient rushed with a definitive prostho (some insurance issue) and I took responsibility for the papillae, insisting to let a space free.
It took 10 months for papillae to fill the spaces.




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13 Comments

Snjezana; Great recovery of papilla. What was IHB measurment here? That would dictate for me to leave open or close space restoratively? Thnx Maurice


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Maurice, exactly the question I have been waiting for.
2 mm were sounded from the marginal gingiva to the inter-implant bone. I counted on additionally 1,5 mm.
(Salama et al: Classification of predicted height of interdental papillae).
Attached are images 4 weeks after provisional bridge delivery. Papillae were present. I can`t explain what happened afterwards. Patient had some appointments at restorative dentist, may be some trauma, may be repeatedly abutment disconnection?
Best regards
Snjezana


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I saw the photographs of this case and I knew right away it was your work! Awesome work doc.


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Thank you, Warren!
Best regards
Snjezana


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Snjezana,

Nice work- Time is of the essence... I notice that the concentration is on the right lateral - however, in the anterior zone 8-10 - the Pontic design changed and they appear to be non ovate- especially #10- which looks ridge lap- and I know you do not like pink - and prosthetically could be nice development with tissue shaping - Is this what you are saying rush to final ? Was done by outside lab? Ive been down this road a few times as you know...

See you in a few weeks

Cheers,

Richard



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hi Snjezana, great case, great managemente of soft tissues. ON july pic you were very brave to screw with that kind of papilla missing issue...Same patients has food impact and worsen the prognosis. Fortunatelly not in this case. Provisional images are GREAT! Wonder what had happend. Thanks for sharing, and hope to see you soon. Regards, Jorge


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You are right, Jorge, and I¨ve already seen papilla spaces constantly occupied by food debris. I was pretty sure that this patient will clean properly-he took the entire treatment very seriously. Thank you for your input, see you at OWS in three weeks! Snjezana


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hi Snjezana, great case, great managemente of soft tissues. ON july pic you were very brave to screw with that kind of papilla missing issue...Same patients has food impact and worsen the prognosis. Fortunatelly not in this case. Provisional images are GREAT! Wonder what had happend. Thanks for sharing, and hope to see you soon. Regards, Jorge


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WOW GF! What a beautiful result. Did you check patient medications? I have a few cases with medication induced papilla fill.


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Chuck, I came yesterday across these pics when I was working on my OWS lecture. When I uploaded the case the same idea crossed my mind, especially because of gingival growth in the low jaw. Today I checked: no medication. See you very soon Snjezana


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Great discussion here. Thanks 🙏


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Amazing case Snjezana! Biology dictates the result :) It is a very common finding to see restorative part influencing in a good or bad way the surgical result.. Chuck what meds do you refer to? Ca channel blockers? Ioannis


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