Healing Abutment and Cautery. Does healing abutment reduce need to trim the gum?

Healing abutment is placed either right after implant placement or after phase II surgery(uncovery of implant when it was buried under the tissue) to be able to access implant later. When healing abutment is placed there is a biological change on bone and soft tissue. It is called biological width. This will happen any time something gets attached to implant with exposed tissue. This is due to exposure of implant-abutment junction to environment and this process can take up to about 2 months. The best treatment outcome can be achieved by custom made healing abutment or temporary implant crown for anterior teeth. This customization of tissue will help developing emergence profile for the best esthetic outcome and can be used to fabricate custom abutment for the final restoration.Your question sounds like you are ready for phase II surgery to uncover the implant. Surgeon can either use laser or blade to expose your implant. There is a preparable permanent abutment that can be trimmed after tissue healing and the process is just like crown preparation. But we see decline on this process due to technical challenges. I would recommend placing healing abutment if it is posterior or place temporary crown if it is anterior tooth. Let your tissue heal and treat with custom abutment and crown (cement retained crown) or screw-retained crown. Usually there is no need to trim the tissue after healing abutment as long as you have custom abutment vs pre-fabricated abutment.

When an implant is placed into the bone, there are two possible ways for it to remain while healing (osseintegrating). It can either be covered with gum tissue and be left to heal submerged for a period of time, after which the gums are opened up to expose it (a procedure referred to as "second stage surgery", which can be done either with a scapel or laser). The other option is a healing abutment is screwed onto the implant at the time of surgery which sticks up above the surface of the gum and is worn as such while the implant heals. The healing abutment prevents the gums from closing up over the implant eliminating the need for second stage surgery. Once the implant is fully integrated, the healing abutment can be removed to access the implant and restore it with a tooth. Sometimes, however, the healing abutment results in the gum profile healing in a shape that doesn't ideally match that of a tooth, so the gums may need to be recontoured to allow for a better shape tooth.

function of healing abutment is , to form proper tissue around permanent abutment. laser / cautery - tissue cuttingprocedure is as followseep1. implant placement with cover screw2. expose cover screw from soft tissue > with help of blade / laser / cautery3. put healing abutment > once soft tissue heals4. put regular abutment with crown .

The primary function of the healing abutment is to create a channel from theimplant through the gum (similar to a pierced ear).  The crown is then connected through this channel to the implant either directly as a screw retained crown or cemented on a sub structure called an abutment.There are pros and cons to using a healing abutment.  The first is that it alleviates the need for a second surgery and in most cases a implant crown can be restored without needing any anesthesia.  A con is that if there is need to have ideal gum tissue alignmentand symmetry or if the tissue is very thin then you may not have an opportunityto address these concerns after a healing abutment is placed.Implant healing abutments are usually not placed at the time of implant surgeryif there is a need to modify the gum tissue or if the implantdoes not have the right about of stability and grip when surgically placed.In these cases the surgeon may use either scalpel blade, tissue punch, laser, orelectrocauter/knife.  All are sufficient to uncover an implant it just depends onhow you want your gum tissue to respond to this stage of treatment.Another option is that during the implant placement stage, a impression of the implantis made simultaneously and this will go to a lab to have a custom healing abutment or custom temporary crown made that may be used 3-4 months later when theimplant is uncovered (second stage).  Again In this part of my answer I am referring to when the implant is submerged under the gum during implant surgery and no healing abutment is placed.  This technique will generally give you the most optimal outcomewhen gum tissue is of the most concern.