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?
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.