Every once in awhile we encounter a patient where replacing lost alveolar bone and gingival tissue can not be accomplished with our routine procedures. When confronted with loss of periodontium that causes and esthetic compromise my go to list of procedures starts with surgical replacement. There are times when the skills of the surgeon and the techniques currently available aren’t enough. Next I think about restorative solutions that might include long contacts, pink porcelain or pink composite to “hide” the missing biologic tissues. Again, I run into situations where these are not viable solutions, or are simply not enough. The limitations can often be hygiene and the ability to keep the area clean and not create a situation where infection is the risk, or the final esthetics simply may not be tolerable.
I encountered just this situation recently with a patient and had to dig in the back of my memory for another solution. The patient came to me with an implant fixture already placed for the upper left central incisor. Immediately I diagnosed loss of bone and gingival tissue as an issue and we set about correcting the clinical situation. Several rounds of surgery got things as good as possible, and fortunately the facial responded well. We combined this with crown lengthening on the other anterior teeth and restorative magic to achieve an acceptable result from the facial. The challenge remained that the fixture was exposed on the palatal and drives the patient’s tongue crazy as well as traps food. Covering the fixture threads with restorative material adds the risk of food entrapment and peri-implantitis.
Years ago I learned a technique from Frank Spear that he called “Party Gums” where he made a removable gingival mask for a patient who had suffered from severe periodontal disease. I proposed this idea to my patient and she was game to try anything. I used the pink silicone reline material from Tokuyama and injected it around the exposed implant and into the gingival embrasures both mesial and distal to the tooth. After allowing it to set I used a scissor to trim the thin ragged ends, making sure to leave the interproximal fins. The patient immediately fell in love with it as it felt so smooth and her tongue finally stopped rubbing on the implant threads. It took just a moment to show her how to place and remove the gingival mask. She has since let us know that it works extremely well and stays in place even when eating as long as the food its not super sticky.