When your implant abutment or crown/bridge framework on an implant won't seat, chances are it's a tissue issue.When you seat your provisional abutments and temporary crown the tissue will heal beautifully to what you have made and sculpted. However, your lab technician may have other ideas.
If you haven't specifically told the lab that they can or can't adjust the stone tissue around the implant analog, they may go ahead and design an abutment shape that supports the bridge or crown casting ideally but will not seat in the mouth when you do your try-in appointment. The tissue will be in the way and although it may look like it's seated, and the x-ray may show it's seated, it is NOT.
Tissue and Abutment Shape
You need to pay attention to the shape of the abutment. If there is a flare off to the proximal or fullness on the facial or palatal, chances are really high that you will have to laser or electro surge the tissue to get it to seat passively. Any slight pushback when seating an abutment with finger pressure indicates there is tissue in the way. If you can prepare the patient for anesthesia and a minor tissue removal procedure before you have to do it, the patient will more likely accept this as part of the treatment protocol and not something that went wrong.
Take the time to discuss with your implant lab technician how they address designing abutments, and whether or not if it is okay to do any model modification. It can save you a lot of time and frustration during your try-in appointment if you are prepared and know what to expect.
Mary Anne Salcetti, DDS, PC, Spear Visiting Faculty. [ www.maryannesalcettidds.com ]
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