Management of implant soft tissue complications in the esthetic zone

The recession of the buccal soft tissue margin is a frequent complication

of well integrated dental implants. The appearance of metallic structure

or even their transparency through the thin buccal soft tissues are

common reasons for patient aesthetic complains. Moreover, bad implant

installation frequently results in excessive apical dislocation of the buccal

soft tissue margin of the implant supported crown.

Soft tissue plastic surgical procedures and bilaminar techniques in

particular, can be successfully used in combination with a pre and

postsurgical prostethic approaches to increase the volume of the

interdental soft tissue, to treat buccal soft tissue dehiscence around dental

implants and to provide the new implant supported crown with an esthetic

transmucosal emergency profile.

Aims:

• To show a combined surgical prosthetic approach for the treatment of

soft tissue dehiscence.

• To provide long-term results showing the stability of the obtained

outcomes.

Learning Objectives:

Participants will learn:

• Solve peri-implant soft tissue complications

• Perform a coronally advanced flap to cover a soft tissue dehiscence

• Harvest connective tissue graft

• Prosthetically manage the soft tissue conditioning after mucogingival

surgery

Regenerative strategy in the treatment of infrabony defects in the

esthetic area

Traditionally the outcomes of the regenerative therapy were considered

the radiographic bone defect fill and the clinical attachment level gain.

Nowadays, in the esthetic area, these aspects are not enough, and the

improvement of soft tissue esthetic appearance along with periodontal

regeneration is of paramount importance.A novel procedure combining

a papilla preservation technique with a connective tissue graft below the

coronally advanced flap will be presented.

The connective tissue graft act as the buccal “soft tissue wall” of the

intrabony defect treated with amelogenin increasing the blood clot

stability to obtain periodontal regeneration and to improve the esthetic

result.

Soft tissue prognostic factor influencing the selection criteria for

regenerative therapy or tooth extraction will be discussed

Learning objectives:

1)Which are the prognostic factors for the success of the regenerative

therapy?

2)Which are the criteria to determine whether to maintain a tooth with an

infrabony defect or extract it?

3)Is it really possible to improve esthetic outcomes in regenerative surgery?