Fig. 1: A 90-degree shift creating a modified ridge lap.In the second scenario, the platform is clearly visible to the eye and presents a significant esthetic challenge. When this situation is encountered in nonesthetic areas, the clinician may choose to leave the metal exposed in the final restoration. However, when dealing with the esthetic zone, two popular techniques are used to compensate for equigingival or supragingival platforms.One option is to prepare the platform with a high-speed handpiece and copious irrigation. The restorative margins are brought subgingivally while leaving the internal platform-abutment interface intact. An impression coping is inserted and retraction cord is placed to permit adequate capture of the margin in impression material. A cementable implant crown is fabricated by the laboratory and delivered.There are several concerns with this approach. The titanium implant is difficult to prepare intraorally. Even with copious irrigation, significant heat will be generated that may damage the bone-implant interface. The dentist must worry about the sparks and debris created upon preparation as well as collateral soft-tissue damage. Extreme care must be used not to alter the internal platform-abutment interface; any alteration will interfere with the precise and passive fit of machined components. Subgingival cement must also be meticulously removed during insertion.This author’s preferred treatment modality is to create a flange of porcelain that covers any exposed implant surface (Figs. 2 through 6). The major disadvantage is that the dentist has traded an esthetic problem for a hygienic one. The porcelain flange acts like a full ridge lap and requires diligent home care to dislodge plaque and food debris from accumulating.The porcelain flange may extend subgingivally if there is any depth of tissue around the platform. Alternatively, the flange may extend supragingivally along the facial contour of the ridge. Both scenarios present the hygienic problems of a full ridge lap.