The significance of surgically modifying soft tissue phenotype around fixed dental prostheses: An American Academy of Periodontology best evidence review

Abstract

Background This systematic review endeavored to investigate the effect of soft tissue phenotype modification therapy (PhMT‐s) at sites with a tooth or an implant supported fixed dental prosthesis. Methods A comprehensive literature search was conducted by two independent examiners to identify relevant studies reporting differences in clinical, esthetic, or radiographic outcomes of interest between sites underwent PhMT‐s and sites that remained untreated. Risk of bias assessment was calculated for all included studies. Meta‐analyses involving endpoints of interest were performed when feasible. Results No controlled studies pertaining to tooth sites were identified. A total of six articles reporting on the outcomes of buccal soft tissue phenotype modification around implants were selected, of which, five were included in the meta‐analyses. Quantitative analyses showed a weighted mean difference (WMD) of 0.98 mm (95% CI = 0.25 to 1.72 mm, P = 0.009) for change of tissue thickness; a WMD of −4.87% (95% CI = −34.27 to 24.53%, P = 0.75) for bleeding on probing (BOP); a WMD of 0.36 mm (95% CI = 0.12 to 0.59 mm, P = 0.003) for mucosal recession (MR); a WMD of 0.13 mm (95% CI = −0.11 to 0.36 mm, P = 0.30 for probing depth (PD); a WMD of 1.08 (95% CI = −0.39 to 2.55, P = 0.15) for pink esthetic score (PES), and a WMD of 0.40 mm (95% CI = −0.34 to 1.14 mm, P = 0.28) for marginal bone loss (MBL). Conclusions Surgical modification of peri‐implant soft tissue phenotype via PhMT‐s may decrease the amount of MR. Future clinical trials are needed to warrant the clinical benefits of modifying soft tissue phenotype around tooth‐supported restorations.

The fate of the distal papilla around tooth‐bound implant‐supported restorations in maxillary central incisor sites

“…9,18 Additional horizontal and vertical soft tissue augmentation for peri-implant phenotype modification may contribute to boost the esthetic outcomes. 19,20 Whether immediate or delayed, implant placement in an unfavorable position can also influence the esthetic outcomes of tooth replacement therapy. Inaccurate implant placement can lead to the occurrence of distal papilla deficiency because of, for example, an excessively deep position of the restorative platform, which may induce severe saucerization and extensive peri-implant bone remodeling, and/or close proximity to the lateral incisor.…”

The Merit to Phenotypic Modification Treatment for Dental Implants: Two Case Reports

“…It has been suggested that the thin tissue phenotype around dental implants is at a higher risk for increased inflammation. 5,7 This may be due to plaque accumulation resulting in a biofilm that can cause ‡ Gem-21S, Lynch Biologics, Franklin, TN † Gore-Tex Suture, W.L. Gore & Associates, Flagstaff, AZ ‡ NobelActive Parallel Wall, Nobel Biocare, Yorba Linda, CA § Smart Peg, Osstell, Cumberland, MD inflammation.…”

“…However, the presence of keratinized tissue may help reduce a patient's inflammatory response associated with peri-implant mucositis, comfort during mastication, and ease of plaque removal. 5,6 Two dental implant cases are presented where PhMT has been performed in either a reactive or proactive manner involving subepithelial connective tissue grafting to increase periimplant keratinized tissue. The resulting outcome created an improved environment conducive to maintaining long-term peri-implant health and function while also trying to maintain esthetics when PhMT is performed proactively.…”

“…This recent BEC panel also found limited evidence linking peri‐implantitis to a lack of peri‐implant keratinized tissue. However, the presence of keratinized tissue may help reduce a patient's inflammatory response associated with peri‐implant mucositis, comfort during mastication, and ease of plaque removal 5,6 . Two dental implant cases are presented where PhMT has been performed in either a reactive or proactive manner involving subepithelial connective tissue grafting to increase peri‐implant keratinized tissue.…”

“…Moreover, the reactive approach to care can be both challenging and unpredictable. It has been suggested that the thin tissue phenotype around dental implants is at a higher risk for increased inflammation 5,7 . This may be due to plaque accumulation resulting in a biofilm that can cause inflammation.…”