When the Body Hurts… But the Surgery Still Flows

Some days are heavier than others.

The foot still isn’t right.A strange kind of pain — almost ironic — because I haven’t touched alcohol in a month…and yet, intense exercise alone can trigger an inflammatory storm.

A gout-like crisis, sparked not by excess…but by effort.

Amazing what you learn through your own body.

It’s fascinating. And brutally painful.

So painful that, for a moment, you lose even the ability to think positively.

And then… I remembered something.

I watched Benja in Zander’s TED Talk — The Art of Possibility.

And suddenly, even pain became a place where possibility could exist.

But dentistry doesn’t wait.Life doesn’t wait.

So you clench your teeth…and you keep going.

Because sometimes, we find possibility inside the pain.

A Posterior Case That Taught Another Lesson

In the middle of this medical setback, the day still brought something beautiful:

Another implant case.Another challenge.Another reminder that surgery is never just mechanics…

And never an excuse for overtreatment.

Again, one of those posterior molar sites — very similar to last week:

• No keratinized tissue

• A horizontal defect

• Soft tissue limitations

  
  

But this time…

The implant would sit entirely inside the four bony walls.

And that changes everything. Regeneration becomes debatable. well....Debatable for me…

But for the majority of dentists, it becomes reconstruction after reconstruction —the ideal playground for overtreatment disguised as “ideal care.”

Not mandatory.Not automatic.

Sometimes, the best graft… is restraint.

Keep it simple. Keep it smart.

So we chose a supracrestal platform approach, with a clean, elegant healing strategy.

The left model represents a knife-edge ridge configuration, where part of the implant’s rough surface may remain exposed. In such situations, grafting with a biomaterial and a membrane becomes necessary to achieve proper coverage and long-term stability. In this approach, the implant’s polished collar is positioned deeper, and soft tissue outcomes often depend on additional regenerative procedures (GBR) to compensate for the limited keratinized mucosa. The keratinized tissue is frequently displaced buccally both by the GBR volume augmentation and by the prosthetic tulip/platform design, to establish an adequate tissue profile. In contrast, the right model illustrates a supracrestal platform strategy combined with healing abutment–guided soft tissue adaptation. Here, because the rough surface remains completely enclosed within the bony walls, there is no strict biological requirement for grafting. Although GBR may still be performed to further enhance buccal volume, in many cases, simple buccal repositioning of the keratinized mucosa is sufficient to create a stable and functional emergence profile. The mucosa is actively stabilized around the healing abutment at surgery, allowing soft tissue thickness gain and maturation with reduced dependence on regenerative intervention.

TLX 3.75 × 8 mm — Primary Stability at Its Best

The implant locked in beautifully.

That deep, reassuring stability —the kind that reminds you why modern implant design matters.

An 8 mm implant.A demanding site.

And still…

Primary stability: top notch.

The Real Trick Was Not Bone… It Was Tissue

Here was the key:

The residual mucosa was carefully dissected into two independent parts:

• A vestibular flap

• A lingual flap

  
  

This small detail changes the entire future.

Because instead of simply closing…

We sutured the vestibular portion directly around the healing abutment, using resorbable 5-0 sutures in a circular adaptation.

Not just to seal.

But to create.

To build the conditions for something essential:

A future crown surrounded by keratinized mucosa.

Sometimes the Hardest Cases Are the Quiet Ones

No dramatic graft. No heroic biomaterial mountain.

Just anatomy.Precision.Soft tissue intelligence.

Because in implantology…

Success is often decidednot by what you add…

But by what you respect.

Will there ever be a tooth equal to a natural one?

No.

However.....

There will be a ceramic implant-supported crown that will do the job beautifully.

(See the blog post about the art of rehabilitating tissue-level implants in the posterior maxilla and mandible.)

Even in Pain… We Move Forward

The body complains. The joints scream.

And yes… pain can enter your mind.

But the work continues.

Because every difficult day still carries a lesson.

And even when you limp into the clinic…

Surgery, somehow, still teaches you how to walk straighter.

A true surgeon does not fight the anatomy. He aligns with it. And please…Do not overtreat people. There is a person at the very end of your blade. Treat them with respect

You tailor the technique to the patient ..not the patient to the technique, remember that !!!!

have a nice Day ANdre