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After most extractions, a loss of facial bone occurs in the
vertical and horizontal dimensions. This bone loss can
be regained surgically or prosthetically; however, adding
facial bone around an implant requires the use of grafts,
barriers, and techniques that are often more advanced
than the average practitioner is prepared for. Therefore,
preserving the facial and lingual surfaces with bone at the
time of extraction is a more predictable procedure. If the
surgeon is not familiar with these techniques, however,
and their value is not communicated to the patient, the
patient will likely experience a site collapse (Figs. 1a–1c).
The most ideal time to augment the soft tissue profile is at
the time of conventional implant placement.
Figure 1c: This can give the final crown the appearance of being “stuck” on
the gingiva.
■ Understanding the Limitations of
Stock Components
Stock or standard abutments are designed in the shape
of a perfect circle at the shoulder, or prosthetic base, of
the abutment. The problem with this standard design is
that no naturally occurring tooth is perfectly round at
the alveolar crest or the cementoenamel junction (CEJ).
While flared healing abutments are available, these
stock components still provide only a generic solution,
forming gingival contours that may be less than ideal for a
specific patient.
Figure 1a: After extraction, there is often site collapse necessitating implant
placement further palatally to ensure 2 mm of bone on the facial aspect of
the implant.
To sculpt the soft tissues around an implant, the surgeon
or restorative dentist should mimic the shape of the soft
tissue around the natural tooth in that same area. There are
numerous ways to do this. Many dentists take an implantlevel
impression, insert a round healing abutment, and
let the laboratory do the rest (Fig. 2). But if the laboratory
makes an overly bulky crown or abutment that squeezes,
pushes or compresses the gingival tissues, there is no way
to account for the potential recession that can result. If the
dentist places a stock final abutment on the implant and
Figure 1b: In such cases, to ensure proper occlusion and esthetics, the restoration
requires a facial cantilever of porcelain.
Figure 2: Implant placed properly in center of ridge. Note there is no tissue
sculpting with this conventional, non-contoured healing abutment.
– The Critical Nature of Tissue Contouring from a Periodontist’s Perspective – 51