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Implant/Connective Tissue Graft Inquiry
- Courtesy Periodontal discussion group

I have a patient who was referred to me last year. She has an implant in the #9 position, placed by another periodontist. The implant is a 3i XP 5/6 (5 mm body with a 6 mm seating platform). The implant was placed at the crest, a little to the facial and a little closer to #10 than to #8.

The restorative dentist did platform switch in restoring the implant. The restorative dentist subsequently referred the patient to me, because of metal show through and recession.

I have tried a connective tissue graft twice to cover the head of the implant. Each time there has been breakdown and recession in the mid-facial of the implant.

I believe that it is due to the implant platform being 6 mm and being out of the normal contours. This leads to too much pressure on the tissue, which leads to breakdown and recession.

I wonder if I shaved the facial edge of the seating platform back and then performed a new CTG, would I have greater success. I also wonder if there is something else that I may be missing or should try. I would appreciate any feedback. - David

Hi David this is Dr.Rajesh Naik, consultant periodontist and implantologist from chandigarh, India.

Well i went trough your query and it one of those clinical situation where in soft tissue grafting can have a high success depending on the amount of metal exposure (widthwise) and i personally feel shaving of the metal platform wouldnt be a great idea...would rather create a rough surface where the plaque starts accumulating....

My opinion... when you have given your sincere effort in covering up the exposed area and result is unsuccessful...then reasons could be excessice metal surface areas to be covered and C.T. graft needs a good periosteal bed than anything else for a favorable prognosis and it is one of the most sensitive periodontal plastic surgical procedures...

The best way is to ask your lab technician add a pink acrylic gingival collar to prosthesis.I hope this - Rajesh Naik