Biological basis for soft tissue management in implant dentistry

Abstract

Good aesthetic finish of implant ⁄ restorations requires healthy peri-implant soft tissue at the appropriate location. The relevance of the peri-implant soft tissue seal, the biological width, the keratinized gingival zone and the need for effective plaque control in order to maintain peri-implant soft tissue health were discussed. The presence of a soft tissue seal ⁄ cuff around dental implants and abutments and its role in defense against infection were convincingly demonstrated in animal studies. In order to achieve long-term stable peri-implant health, it is important to achieve an adequate soft tissue seal around dental implant ⁄ restorations. The constant dimension of a biological width (of the soft tissue) often dictates where the final gingival margin will be. It is therefore not surprising that the position and stability of the alveolar bone ridge surrounding dental implants ultimately determines where the gingival margin rests. For dental implant restorations in the aesthetic zone, this is a crucial variable for the clinician to understand and deliver. Available data so far suggest that with good oral hygiene, peri-implant soft tissue health can be maintained irrespective if a keratinized gingival tissue zone surrounding implant ⁄ restoration is present. In reality, good oral hygiene is very difficult to achieve around dental restorations without the protection of a band of keratinized gingival tissue. Studies on peri-implantitis and peri-implant mucositis further demonstrated the causal relationship between dental plaque accumulation and peri-implant inflammation. It is therefore imperative that long-term maintenance care of dental implants and implant supported dental restorations should include a strict regime of plaque control and monitoring.

The biological seal of the implant–soft tissue interface evaluated in a tissue-engineered oral mucosal model

“…The clinical importance of the BS around the implant has been identified as a dominant factor to determine the longterm success of peri-implant health [3,4]. However, it has been suggested that the quality of the BS of peri-implant tissue is weaker than that of the junctional epithelium on the natural teeth [1,5,6].…”

Connective tissue graft to improve aesthetic peri-implant area: modified clinical technique.

“…One alternative is to attempt soft tissue augmentation around the unaesthetic restoration. The sub epithelial connective tissue graft concept may be useful to augment soft tissue around previously restored implants in an aesthetic zone [13][14][15][16][17]. In this clinical case was applied the distal wedge technique associated with the free gingival graft technique to obtain an adequate quality and quantity of sub epithelial connective tissue graft to recover the compromised areas.…”

“…The aesthetic finish of implant/restoration interface always requires healthy peri-implant soft tissue at the adequate location [8][9][10][11]. In this case, it was suggested that surgical manipulation/augmentation of peri-implant soft tissue may be beneficial to increase the width/thickness of gingival keratinized tissue and also to improve aesthetic outcomes of implant therapy [12][13][14][15][16]. The sub epithelial connective tissue graft is a gingival plastic surgery that may be used to enhance the aesthetic and gingival contour of the periodontium [17,18].…”

Soft tissue manipulation for single implant restorations

“…The nature and quality of junctional tissues differ between natural teeth and implants. 4 As such, creation of an optimal 'emergence profile' on implant retained crowns can be challenging. This Achievement of optimal aesthetics on implants in the anterior region can be difficult due to inherent differences to the natural dentition.…”