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Implants · patient case question

How should the prosthesis design be modified to prevent recurrence?

Patient case: Implant Maintenance Problems

demo: 57-year-old female

chief: “The gums around my implants bleed and food gets stuck underneath.”

history: Edentulous maxilla restored with an implant-supported fixed prosthesis 3 years ago. Former smoker.

meds: None

findings: Bleeding on probing and erythema of the peri-implant mucosa at three sites. Radiographs show no bone loss beyond the initial remodeling. The intaglio of the prosthesis is concave, with food packing at the tissue interface.

  1. Make the intaglio surface more concave to create a cleansing reservoir
  2. Reshape the intaglio surface to be more convex, eliminating areas where debris collects
  3. Add interproximal contact tightness to block food entry
  4. Extend the flanges further onto the mucosa
Show answer and explanation

Correct answer: B. Reshape the intaglio surface to be more convex, eliminating areas where debris collects

  • A. Concavity is precisely the problem here — it creates an uncleansable trap.
  • B. Correct. A convex tissue surface bulges gently outward, allowing floss, brushes, and irrigation to sweep the interface. Concavities and ridge-lap contours trap plaque and debris.
  • C. Tightening contacts does not address the tissue-surface contour where the debris is accumulating.
  • D. Extending flanges increases the covered area and worsens hygiene access.

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