What Is a Gingival Former and Why Is It Essential?
A gingival former, also known as a healing abutment, is a temporary suprastructure that the dental surgeon screws into the implant body after complete osseointegration. Visually, it resembles a metal or ceramic bolt with a wide, smooth head. Its main task is to create the correct biological width contour around the artificial root. According to the protocols of the Spanish Society of Periodontology (SEPA) , this stage is considered critical for the long-term success of the prosthesis. Without it, it's impossible to form a dense gingival cuff that will protect the implant-crown connection from bacteria and food particles. It's not just an auxiliary element but a mandatory component of two-stage implantation, recognized as the treatment standard in Catalonia.
Physiology of the Process: How Is the Gingival Cuff Formed?
The process of forming the gingival contour begins immediately after the element is fixed. When the surgeon screws in the former, they lift the mucosal flap and fix it at the level of the future crown. The body perceives this element as a foreign body, but due to biocompatible materials (Titanium Grade 4 or zirconium dioxide), it does not trigger a rejection reaction. Fibroblasts — connective tissue cells — begin to proliferate around the smooth surface of the head. In about 10-14 days, the epithelium attaches to the former's surface, creating a dense ring — the cuff. This cuff will later act as a natural barrier. It's important to understand: if you skip this stage and immediately place the crown on the bare implant, the gum may not form correctly, leading to its recession and exposure of the metal.
Indications for Placement: Who Needs It and When?
Gingival former placement is indicated for all patients after the osseointegration period is complete. The titanium root integration process takes 3 to 6 months: in the lower jaw, this period is usually 3-4 months; in the upper jaw, it's 5-6 months due to lower bone density. Once osseointegration is radiologically confirmed, the cover screw is replaced with the former. The procedure is indicated for both men and women of any age (over 18, after jaw growth completion). Contraindications may only be acute inflammatory processes in the oral cavity at the time of surgery or unsatisfactory hygiene. In Barcelona clinics, before this stage, a control orthopantomogram or Cone Beam Computed Tomography (CBCT) is always performed to assess bone condition and implant position.
Abutment vs. Former: What's the Fundamental Difference?
Patients often confuse these two elements due to their external similarity. However, their functionality is completely different. The former is a temporary tool for creating the mucosal contour. It is placed for 2-4 weeks and then removed. The abutment is a permanent connecting element that serves as the base for fixing the crown. It can be made of titanium or ceramic (zirconia) and remains in the mouth for the entire lifespan of the prosthesis. There are also universal abutments that act as formers, but classical implantation protocols use the separate technique. In Spain, according to the European Federation of Periodontology (EFP) guidelines, separating these stages allows for a more predictable aesthetic result, especially in the smile zone.
Design and Materials: Titanium vs. Zirconia
Technically, the gingival former consists of two parts: apical (screw part) and coronal (head). The screw part has micro-threads for secure fixation in the implant. The head, protruding above the gum, has a smooth, polished surface that promotes correct epithelial attachment formation. The head height varies from 1 mm to 10 mm and is selected individually based on the patient's mucosal thickness. The manufacturing material is either medical titanium or zirconium dioxide. In Barcelona, for anterior teeth (frontal group), zirconia formers are often chosen. They do not show through thin gums with a bluish tint, guaranteeing natural aesthetics. Titanium analogs are optimal for the chewing group, where biological tissue translucency is not a concern.
Types of Gingival Formers: Standard and Custom Solutions
In modern implantology, also according to 2026 protocols, two main types of formers are used. Standard ones are manufactured by implant system manufacturers. They have fixed diameter and height dimensions. This is an economical and quick solution for typical clinical situations where soft tissue volume is sufficient. Custom formers are manufactured on demand using CAD/CAM technologies. They are necessary in complex cases: atypical ridge shape, very thin gingival biotype, or implantation in the smile zone. Digital modeling allows creating an ideal emergence profile, which in 98% of cases eliminates the need for subsequent gum plastic surgery. This is especially relevant for patients in Barcelona who value high aesthetics.
Surgical Protocol: How Is It Placed?
The gingival former placement procedure is performed under local anesthesia and lasts no more than 20-30 minutes. First, the surgeon makes a micro-incision (or uses a punch) over the implant site to access the cover screw. Then, the cover screw is unscrewed, and the implant's internal cavity is irrigated (rinsed) with an antiseptic solution. After that, the former is screwed in using a torque wrench with controlled tightening force (usually 10-15 N/cm) to avoid damaging the internal connection. Sutures are placed around the element, leaving the former's head open above the mucosa. In modern practice, especially in Catalan clinics, laser scalpels are increasingly used, which prevent bleeding and accelerate healing.
Timing and Stages: When Is the Gingival Former Removed?
The wearing time for the former is determined individually, averaging 10 to 14 days. During this period, complete wound epithelialization and the formation of a stable gingival margin occur. In some cases, such as thin mucosal biotypes or when using additional materials (e.g., platelet concentrates), the period may be extended to 3-4 weeks. A follow-up examination is performed on days 7 and 14. If the gum has formed evenly, without inflammation or hypertrophy, the former is removed. Immediately after, the prosthodontist proceeds to take digital impressions (scans) for the fabrication of the permanent abutment and crown. In Barcelona, this process is fully digitalized, eliminating errors typical of classic impression materials.
Normal vs. Pathological: Possible Complications
After former placement, the patient may experience various symptoms. Normal reaction: slight swelling, mild soreness for 2-3 days, a small amount of exudate. Body temperature may rise to subfebrile levels (37.1-37.3°C). Alarming symptoms (require a doctor's visit): heavy bleeding, purulent discharge from under the gum, severe throbbing pain, mobility of the former itself. If the former falls out or becomes loose, you must urgently contact the clinic, as soft tissues will quickly close, making reinsertion difficult without a new incision. In Spanish practice, the rule is strictly followed: any displacement of the suprastructure requires X-ray control to rule out implant overload.
Prevention and Care: Patient Guide
Oral hygiene during the former wearing period is crucial for the success of the entire implantation. Eating is prohibited for the first 3-4 hours after the procedure. During the first week, smoking and alcohol must be avoided, as nicotine and ethanol drastically slow down blood microcirculation and healing. Brush your teeth with a soft brush, carefully avoiding the surgical area. To clean the former itself, it's recommended to use a single-tuft brush and an irrigator with an antiseptic solution (e.g., 0.05% chlorhexidine digluconate). Food should be soft, pureed, at room temperature. Hard, spicy, and sticky foods (nuts, crackers, toffees) are excluded to avoid traumatizing the healing zone or displacing the element.
Conclusion and Specialist Recommendations
The gingival former is not just an intermediate stage but the foundation for the aesthetics and longevity of your future crown. Neglecting this stage or trying to save money by not placing a quality healing abutment can lead to serious consequences: from gum recession to peri-implantitis. The doctors at the «Corona Dental» clinic in Barcelona strictly follow international protocols and use only certified materials. We perform mandatory digital control at all stages — from implant insertion to former fixation. Remember: a beautiful and healthy smile starts with properly formed gums. Entrust your health to professionals and follow all care recommendations.
