Darin O'Bryan, D.D.S. When temporizing anterior implants, the goal is to train the gingiva to get the final shape and height that we need for a good esthetic result. When we have an implant that the tissue is more gingivally positioned than we would like we can use the temporization phase to help migrate the tissue coronally.
Here is a case where the tissue was too apical.
When fabricating the temporary, we want to under contour the cervical area to allow the gingiva to grow into that area. Here is the temporary with a cervical constriction shaped into it to allow the gingiva room to move into.
Now we let this area heal and check on it in 3 weeks and see if we are getting the tissue movement that we want.
As we can see the tissue is migrated coronally and we are getting the papillae to fill in.
Next we reshape more off of the cervical to try and get more movement of the gingiva. We continue to do this until we get the desired position or the movement stops. Once it has reached either the desired height or stopped moving, we can then assess the esthetic impact and decide if a connective tissue graft is needed. If no further treatment is needed, the tissue is allowed to mature in this position for another three weeks. Then the final restoration can be fabricated. Care needs to be taken not to put too much pressure with the abutment or the screw retained crown that could cause a relapse due to the excess tissue pressure.
