swollen and tender gingiva around anterior implant

Healthy non smoker, broker her 11 and had it atraumatically extracted with immediate implant placement. It was restored with a white zirconium abutment four years ago and Emax crown.

Today, she complains or gingival soreness at the neck of the crown. I think the tissues are thin around 11 neck and may need some grafting Her biotype is generally thick, fibrous. She is getting shadowing from the implant #11, but isn’t concerned about it. Her probing depths are 1-2 mm and the tissues are pink. It’s mostly the tenderness around the 11 neck that bothers her.

Any suggestions?

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1 thoughts on “swollen and tender gingiva around anterior implant

  1. basselg says:

    I recommend to start with a CT scan. What is her smile line like?
    Aside from the simple stuff like cement stuck down there or a poor implant/abutment margin, it could be lack of a buccal bony wall around the implant due to not accounting for remodelling after immediate implant is placed (see attached diagram). You need a minimum of 6mm from the centre of the implant to the buccal bony wall to avoid a dehiscence and that is very rarely achievable.

    If you recall complication #50 from the Top 100 is not accounting for bone remodelling during immediate implant placement.

    That is why immediate implant in the anterior is a very risky undertaking both in the short and long term. If there Is complete lack of bone on the buccal it will be hard to treat with soft tissue grafting.

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