Hello. I have placed the healing collar 3 weeks ago at second stage surgery. Today patient came for checkup and I noticed there is gingival swelling buccal to healing collar. And the healing collar was mobile. I have tightened it back. There is no pain or any discomfort. Is this normal? Can I go for impression?
Secondly the second molar is tilted towards the implant. Do I need to trim abit the second molar tooth mesially? Is there any chance of gap between the second molar and the implant crown if I don’t trim before impression for implant crown? Kindly help 
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The swelling is most likely the result of the loose healing abutment. While we should not use a torque wrench to seat a healing abutment they should be placed pretty snug. Healing abutment are not indexed and thus have no secondary retentive features making them prone to coming loose and when they do a gap is formed at the implant-abutment interface leading to bacterial accumulation and swollen gums. Make sure the healing abutment is fully seated and tighten to a good snug fit to avoid this. As far as the tilted second molar I would suggest that you get used to seeing this or become very good at molar up-righting because we only place implants in areas of missing teeth and when a molar goes missing the adjacent teeth will act pretty quick to start filling the space. You will likely encounter a lot of mesially tilted adjacent second molars so treat them as you see fit and I will certainly not criticize how you handle it.
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Nothing wrong in doing a little enamel plasty on the molar and biscuspid if needed but remember to do it with the healing cap in place. When you fabricate the implant crown, it should have a broad wide contact area and not a point contact
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