What Are my Options After Implant Placement with Bone Grafting but the Area Above my Tooth is Not As Plump As Rest of Gums?

Question

I had a tooth extraction on the #10 incisor and now have all restored teeth (veneers plus crown). However the #10 seems to be darker because of the bone loss. Can I have more grafting done or something placed inside the gum to plump that area up? I know I can try to build out the veneers more to compensate for the axial inclination but it does not look pleasing. The other option is to have pink porcelain or fake gums put on the veneer but that doesn't seem like a good option cosmetically.

Ira Shapira, DDS · Answer

This can be a difficult problem especially if there is a high smile line.  Sometimes a connective tissue graft under the gingive will give the neded thickness but may resorb over time.  It is also possible to graft tissue from the tuberosity that is less likely to be lost.  

	Another alternative is a custom abutment that has subgingival zirconia built out to support the tissue.  I am currently doing a very difficult base that is utilizing 2 implants with custom zirconia abutments that will have pink porcelain on the abutments and then the crowns will be fit without additional pik needed.

	 

	This gives a much more natural appearance and allows filling not just facial bulk but vertical deficiency

Elly Tehrani, DMD, MSD · Answer

It would really help to see a picture of the area you are concerned about.  To plump the area you can have more bone graft in combination with gum graft. This might help mask the concavity that might be present in the area. It is difficult to say what treatment you might need without pictures/ examination of the site. Is the area dark because there is no bone covering the implant? So the titanium shows under the gum?  Is it showing dark because there is space between the gum and crown? The treatments will be different. So better to have the site evaluated

Bill Williams, DMD, MAGD · Answer

Three options are currently recommended. A 1. connective tissue graft of your own tissue moved from one place, usually the palate or retromolar pad area, to the deficient area, 2. a bone graft, and 3. a hydroxyapetite filler that will not resorb. If there is enough bone and the keratinized tissue is adequate for an implant, the best is the 1st and 3rd options.

	As you can see, implantology is complex, but in the hands of an experienced practitioner, the results are good.

H. Ryan Kazemi, DMD · Answer

Hi

	There are several factors that can contribute to a thinner or 'darker' area near a dental implant. These include thickness of the bone, thickness of the gum tissue, position of the implant, contour of the abutment and contour of the crown. The solution depends of which factors is mainly the problem. If several factors are involved, then each can be addressed to improve the topography and appearance.

	I am sure your surgeon and the restorative dentist can collaborate to assess it and determine the reasons behind it.

	Dr. Kazemi

Mike Ghattas, DDS · Answer

Yes you can have a soft tissue graft done on the site and improve esthetics. Usually a connective tissue graft taken from the palate or using Alloderm (Cadaver skin). 

	 

	Mike Ghattas,DMD

	Diplomate of the American Board of Periodontology

What Are my Options After Implant Placement with Bone Grafting but the Area Above my Tooth is Not As Plump As Rest of Gums?

Answers (7)

Answer: Thin gum tissue above implant

Answer: Thin gum tissue above implant

Answer: Defect around Implant

Answer: Defect around Implant

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What Are my Options After Implant Placement with Bone Grafting but the Area Above my Tooth is Not As Plump As Rest of Gums?

Answers (7)

Answer: Thin gum tissue above implant

Answer: Thin gum tissue above implant

Answer: Defect around Implant

Answer: Defect around Implant

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Recommended reading

Everything you need to know about Dental Implants

Our mission is to create a world where every investment in modern beauty is Worth It.