Management of soft tissues around dental implants

Abstract

Introduction: The absence of sufficient width and thickness of keratinized gingiva around dental implants creates conditions for development of microbial flora with appearance of peri-implantitis. At the 2nd stage of implants surgery the intervention are performed on the mucogingival tissues in order to avoid further complications. In case of soft tissue deficiency around dental implants selection of surgical soft tissue augmentation technique is verry important to obtain good aesthetic results. Basically, three different methods can be applied to augment peri-implant soft tissue: 1. Apically positioned flap/vestibuloplasty (in combination with a free gingival graft) FGG. 2. Mucogingival surgery with free gingival graft (FGG). 3. Soft tissue volume gain by means of a subepithelial connective tissue graft (SCTG). The recent systematic reviews concluded that an inadequate width of peri-implant keratinized tissue is associated with more plaque accumulation, signs of inflammation, soft tissue recession, and attachment loss. Purpose: Assessment of the condition of soft peri-implant tissue and prove evidence of surgical interventions on the mucogingival substrate at the 2nd stage of implant surgery. Material and methods: The study contains seven women with age between 24-64 years with medium of 43,23 years. The methods used: The vestibuloplasty, in combination with free gingival graft-FGG on four patients; subepithelial graft on two of them and FGG on one patient, in sum were performed 22 implants. The data obtained from the clinic and radiologic research’s were operated in the programs: Sidexis 4.2 and Excel. Results: The medium height of the pre-operatively gum - 2,28mm, post-operatively- 6,28mm; medium thickness of the pre-operatively-1,14mm, post-operatively 3,28mm; buccal vestibule with the medium depth of preoperatively - 2,4 mm post-operatively - 5,14mm. Donor zone: rough palatal 6 cases, tuberosity 1 case. Complications were not discovered in neither of cases. The displaying of the implants in 4 cases was followed by a surgery on the mucogingival substrate and in another 3 cases was performed delayed. Conclusions: At the 2nd stage of implant surgery, interventions at mucogingival substrate are indicated in order to obtain a morphofunctional and aesthetic long term results.