One of the most important and difficult pieces of implant prosthodontics is mimicking the beauty of the biology. The tissue position, color and properties are often what gives away that this is dentistry not a real tooth.
One of the ways we can understand our impact on the tissue position is to watch for blanching. When seating an abutment/crown if the tissue blanches you are putting pressure on it and it is going to move. In the area of the free gingival margin, blanching means the tissue will move apically. For papilla it means we will push the tip of the papilla incisally.
So the first question to answer is where you want the tissue. This will allow you to determine if you want to see blanching or not at the time you seat. I make screw retained custom implant provisionals on the largest majority of my anterior cases in order to perfect the tissue position before we go to the final restoration. When I do see blanching at the time of seating I set a timer for 10 minutes and make sure the tissue has returned to normal color. If the tissue is still blanched after 10 minutes, I do not want to risk tissue necrosis, so I will reduce the emergence profile to relieve some of the pressure.
Even at 10 minutes you will be able to see the tissue has migrated due to the pressure placed on it. This will continue over some time, so I recall the patient at 30 days and evaluate tissue position in the provisional, and can then make changes to emergence profile to adjust it as necessary.
Thank you for the 10 minute tip. I am a graduating dentistry student in Manila. We have a big problem with bad veneers since everyone here wants to be Ms.Universe.hahaha I’ll see if this can be used for veneers also. Thank you thank you again.