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Pericumositis - Perimplantitis: IM Macon
Dr. Ennio Calabria
Excerpt from the book:
Latest Generation Short Implant | Page: 149 | Case 9
© Martina Editions
Patient C.A.M., age 47, with implants placed in region 45 - 46 (Fig. 1 - 2).
This case is emblematic in that it manifests the complications that occur when the base of the abutment is placed below the limit of the bone crest incorrectly, without respect for the biological width. This is explained because good tissue conditioning in the early stages is compromised by the patient's difficulty in carefully cleaning the part. Flossing and brushing have a less smooth path, one year later, in 2015, the patient presents with hypertrophied and swollen pericoronal tissues with resorption extended to the cortical surface of both implants up to 3/4mm deep. Two higher extended abutments were inserted, so as to decompress both bone and tissue, placing the base of the abutments on an ideal line higher than that bordering the cortical bone, by 1.5mm. (FIGURES 3 - 4).
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Subsequent checks performed in 2016 and 2020 (FIGURES 5 - 6), show gradual steady improvement. This and other similar experiences have matured some procedures or guidelines of IM-Macon systematics:
1. It is preferable to use the abutments in the stages of escapement since being of various heights and diameters they will be chosen identical to the definitive abutments and tissue maturation will be precise (healing screws are standard and although they have at least two types both in height and diameter, they cannot be as precise as the abutment itself that we will eventually use). It may sometimes happen that the abutment having a greater height than the healing screw may interfere with the occlusal board; in that case, it will suffice to shorten it or taper it if necessary.
2. The distance between the margin of the base of the abutment and the bone crest should be at least 1.5 mm, and these are not enough; we should raise them to at least 2.7/3mm as in the distal sector of 46 and mesial 47, where a compromise was adopted.
3. It is preferable to place not only the abutment as in step 1, but even a well-polished provisional in order to have ideal tissue conditioning.
4. It is advisable to place a provisional anyway, before moving to final impressions, increasing the base volumes by a few tenths of a millimeter, ischemizing the tissues, to ensure better parabolas, and more voluminous papillae, as we would normally do with a periodontally guided prosthesis.
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Excerpt from the book
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