Thank you for taking the time to read this post. For subcrestal implants, can you place zirconia subcrestal as this xray shows? or should we make a titanium abutment up to the height of the bone then zirconia where soft tissue starts?
I'm concerned that zirconia subcrestally will cause the bone to resorb followed by soft tissue shrinkage.
Don't forget that reputable companies like Straumann actually make a zirconia fixture so I do not believe that your line of thinking is correct. I would always recommend a titanium abutment but that is just my opinion.
Even though companies like straumann are selling zir implants (made by neodent, Brazil, that is like saying alpha bio is Nobel) I am yet to see a seminal paper about long-term zir implants and zir abutment stability and its relation with bone and soft tissue at the prosthetic connection level. So in the mean time I would use ti abutment (good implant with best connection, have shown long, long, long stability and predictable outcomes). If soft tissue aesthetics is the problem, soft tissue management will be the most likely answer. A simple trick is the use of a small amount of a bifasic ceramic grafting material on top of the implant and around the abutment's neck, since it's white and hidroxiapatite stimulates the fibroblasts reproduction and gets them to produce more collagen, you will get a pink and increasingly better gum with time. Cheers
Interesting tip with the ceramic graft. Would you mind sharing which brand you prefer to use and when you place it in during the implant or crown placement?
Hi, i use Easygaft crystal from Switzerland, since 2011, which is a self aggregating bifasic ceramic material embedded in a polilactic-poliglicolic acid mesh that doesn't need a membrane and does not runs around, is easy-to-use (pack) and blocks out fibroblasts which is also great. Sold in Europe and the US so it's easily available. Cheers
I appreciate the information!
When and how do you place it to bulk out the tissue?
I actually graft 90+% of implants I place, with this material. The application is quite simple, it comes in a wide mouth syringe and it has a plastificant (n2 methyl pirrolidone in water) that comes in the"activator" solution vial and the mixture is the same style as when we used to activate the in office bleaching. After mixing for 30 to 45 seconds you have about 2 minutes to apply and model. The subcrestal placement and the use of concave abutments ( or long neck if you use Morse connections) generate a space that can be filled and works as an anchor to the rest of the material because it adheres to itself, so you can bulk around the abutment. This material specifically does not need a membrane and if you want it can be exposed without need of altering the gum line and so no disruption of the pink aesthetic occurs. Gingival tissue will grow over it and usually one gets nice pink attached gingiva around the abutment / temporary. I also usually do, in the same surgical procedure, a buccal full thickness self contained pocket so I can also graft and better emergence profile and use all or most of the content of the syringe. Turnover for small graft is about 20 weeks and large one 28. Material can be applied directly over the titanium and the studies show that live bone will grow between the material and the implant /abutment, so you don't really get graft implant contact, which is great.
Thank you for taking the time to share this.
Just for reference this was taken directly from Straumann’s website so they are at least claiming it. I have never utilized such a device and until there is sufficient evidence to the contrary I will stick with my tried and true Zimmer TSVM with titanium abutments. I have to assume though that a company with Straumann’s reputation for quality has done some sort of vetting on the product so it is at least an option that is likely to work.
I think the question is which abutment material is best on a titanium implant? My view is that Zirconia has less galvanic potential. At any rate I see less soft tissue inflammation with Zirc.