What would a Periodontist do? with Dr Tae Kwon - Case 9

[@Bahramiish]

Really a shame that you skipped on the SSA Abutment

[@taehyunkwon8167]

Like any other things in dentist, there are always many different ways to achieve successful outcome. I generally prefer to work on the soft tissue in non-esthetic zone once the hard tissue healing is completed. I will later change the width / height of the healing abutment to develop the soft tissue (probably change to 6.5mm D, 4.0mm H healing abutment to give enough emergence). I rarely do SSA abutment technique for posteriors as I can achieve satisfactory emergence with stock healing abutments. The soft tissue emergence needs to be carefully determined based on multiple factors such as the width of the future crown, the depth of the fixture, and the diameter of the fixture. Every case is different and there generally can't be the single best way to fit all cases. Hope this help!

[@Bahramiish]

@@taehyunkwon8167 I think that your approach is not ideal. Letting soft tissues shrink towards your small HA is inferior to producing a chairside SSA. Trying to reshape later on by switching HA will produce more keratinized soft tissue around your implant, unable to adhere to your final restoration (as demonstrated by the several study groups working on 1 abut 1 time). It may be a „satisfactory“ outcome as you said, but SSA is clearly the superior choice. Hope this helps.

[@taehyunkwon8167]

@@Bahramiish I appreciate your comment and this healthy discussion. As I mentioned, there are many different ways to achieve the same outcome. You can certainly continue practicing on what you strongly believe in. Sometimes, I like to place a smaller healing abutment first and let the tissue grow (you can interpret this as shrinkage OR gain in the volume) and push it later. I do like more keratinized tissue around the implants as supported by some literature out there as well. You can use literature to back up any argument / belief. Just as a personal note, I do not practice "I always do this way". I appreciate all the literature and science but I would like to adopt it in my clinical practice for the right cases that work on my hands. Again, I appreciate your comments, feedback and discussion!

[@Bahramiish]

@@taehyunkwon8167 yeah absolutely agree with you. I hope I didn‘t come across as too harsh, that was not my goal. I just think all your surgical steps were formidable, for me personally the SSA would have been the cherry on the sundae that is this case. Let‘s keep in touch!