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Robbie posted an update
Long story short. I inherited this.
But the previous crown had a plastic abutment under it. Did not get a pic if that. Its a Zimmer TVS implant.
The facial margin at the crown/PEEK abutment? Interface was open and full of plaque, no purulence from the gjngival tissue. The platform and threads are notched from a bur.
I took the crown off today, and put a TVS acan body on and scanned it.
I’m not sure what to recommend at this point. She doesnt like the darkness of the threads, she knows thats never going away.
Do i tell her to remove it? Whats the probablility of getting another one in that site after or making it much worse?
Anyways its a tough situation for her and me as it was from the previous owner.
Anh advice or thoughts or even a WTF would be appreciated.
Thanks folks!
Jedediah, Erick and Ivan13 Comments-
I will be the first to drop the WTF: WTF!!!
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Have you considered referring for some soft tissue grafting? That’s the first thing that comes to mind
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I have. She is not motivated for the referral, but I was thinking I could just polish the exposed part and just treated like a tissue level.
How much could she potentially get back with a STG?
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According to David Wong from the Soft Tissue Grafting Course, it all depends on the interproximal bone level.
If you have good interproximal bone level and papilla intact, you can might be able to gain a significant amount of vertical tissue through Connective Tissue Grafting or a Connective Tissue Graft using the tuberosity.
I’m not a periodontist, but It seems like this case would be a candidate for that. @hootstr
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I’ll present it to her tomorrow. She was real disappointed today, as was I.
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I’m sure there’s a kit out there with titanium brushes and burs to completely smooth out the threads. Then take an impression and have a crown made, hopefully zirconium abutment and a porcelain layering, with some pink porcelain over the gums
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Ever used these? @doclalit
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Probably implantoplasty + free gingival graft
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You will be surprised how a big fat juicy tissue graft might help improve a case like this
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Only if it’s big fat and juicy though. Otherwise, why bother?
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Hi doc would a ctg or fgg result in coverage but risk pocketing ?
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Implantoplasty with a tuberosity graft for bigger volume over time could be the answer
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Just spoke with my perio, Wonderful man, but he believes pretty strongly that it should be removed. He also noted that this particular zimmer implant has a very thin coronal collar and would be at risk for perforation, he thinks that deeper bur mark towards the mesial is getting pretty close actually. So polishing it may not be a good idea. I am referring her to him for an evaluation.
I’ll report back what they decide to do.
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