Periodontal Dressing Around Implants

Fig.1 shows the large mesial gingival embrasure at the site of #30 (*), which is more likely associated with excessive buccal exposure of the abutment (Fig.2: *).  Before #31 implant placement (Fig.3: P: parallel pin), a shorter abutment is placed at #30 (from 5x6 to 5x4 mm).  After adjustment of the trajectory, a 4.5x8 mm implant is placed at #31, followed by insertion of a 5x3 mm shouldered abutment (Fig.4).  Autogenous bone graft harvested from the osteotomy is placed in the buccal defect of the implant site, covered by collagen membrane.  The buccal flap is dissected freely to close the wound.  The buccal flap looks so thick that the abutment margin at #31 is subgingival substantially.  It would be difficult to fabricate a splinted immediate provisional with the abutment at #30.  Plastic sleeves are placed on the abutments at #30 and 31 with fair stability.  Perio dressing is applied around the sleeve to protect the wound and facilitate hemostasis.

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Xin Wei, DDS, PhD, MS 1st edition 10/22/2015, last revision 10/23/2015