CDA Essentials 2019 • Volume 7 • Issue 2

33 Issue 2 | 2019 | S upporting Y our P ractice Dr. Dan Kobric Background The original tooth 12 had been treated with a root canal but subsequently developed a periapical lesion. The patient’s treating dentist at the time removed the tooth, placed an implant, and did some bone grafting. About 4 months after the crown for a 3.25 mm-wide implant was placed, the implant failed. The treating dentist recommended placing another implant, which the patient agreed to. The dentist placed a 5 mm-wide implant and it integrated successfully. There were no soft tissue defects. By the time the patient came to see me, it had been about five years since she’d had her second implant placed. Considerations As a clinician, I was concerned about a few things: (1) The obvious concern is the visibility of the metal collar of her implant. (2) The type of tissue that surrounds both the clinical crown and the implant: there is a significant amount of mucosa present ( Fig. 1 ), where we hope to have keratinized tissue. (3) The implant seems big. Relative to the adjacent teeth, the implant crown is a little too large (labial Theviewsexpressedarethoseofthe authoranddonotnecessarilyreflect theopinionsorofficialpoliciesofthe CanadianDentalAssociation. Should the dentist remove the implant and start over, or graft the site? Case Report: An oversized implant may have caused soft tissue loss in this patient Dr. Kobric is a periodontist in Barrie, Ontario, and a part- time instructor in the faculty of dentistry at the University of Toronto. Here, he shares a case where a patient developed an aesthetic soft tissue problem associated with an implant. Figure 1: Photo showing the metal implant collar with mucosal tissue around tooth 12. Figure 2: Radiograph of dental implant in the lateral incisor position. Figure 3: Keratinized tissue in the area around the implant after a soft tissue graft. A 49-year-old female was referred to me from a dentist in private practice. The patient was concerned that you could see the metal collar of her lateral incisor (tooth 12) implant when she smiles ( Figs. 1 and 2 ). The patient was otherwise healthy and had no other implants or periodontal issues.