Periodontal plastic surgery for the implant patient

Periodontal plastic surgery for the implant patient
August 2003
By Anthony Sclar, DMD
Journal of Oral and Maxillofacial Surgery Supplement 1 Зѓў Volume 61 Зѓў Number 8 Зѓў p104b to p104b
You can view the abstract online. A subscription is required to view the full text or it can be purchased online.
Abstract
Modern periodontal plastic surgery evolved from traditional resective periodontal surgery as a result of the development of various reconstructive and regenerative surgical techniques. The impetus for these surgical and biotechnological developments was an increased public awareness and demand for aesthetic dental services. Today periodontal plastic surgery techniques fall under the realm of Зѓ?cosmetic periodontal surgeryЗѓ? and Зѓ?aesthetic implant site development,Зѓ? having applications in cosmetic dentistry as well as implant therapy. These procedures are Зѓ?plasticЗѓ? in nature and are used to manage vestibular insufficiency, aberrant frenum, marginal tissue recession, excessive gingival display, lost interdental papillae, and deficient alveolar ridges, as well as to preserve alveolar hard and soft tissues following tooth removal in preparation for implant therapy or conventional prosthetic restorations.
An anatomic basis exists for the successful application of these techniques to both periodontal and peri-implant hard and soft tissues. Most important, the clinician must understand that the peri-implant soft tissues lack a connective tissue attachment to the permucosal implant structures and do not enjoy the blood supply normally derived from the periodontal ligament around natural teeth. In addition, the peri-implant soft tissues do not enjoy the potential vascular anastomotic connections present in the periodontal soft tissues. These important anatomic differences render the peri-implant soft tissues more vulnerable than periodontal tissues to mechanical and bacterial challenges and can limit the soft tissue volume yielded from the various soft tissue reconstructive procedures performed at implant sites.
Nevertheless, soft tissue preservation and reconstructive techniques can be used not only to enhance the aesthetic results obtained in the partially edentulous implant patient but also to improve the functional results obtained when implant therapy is used to treat the edentulous patient suffering from alveolar atrophy. Application of these techniques in implant therapy requires a meticulous surgical technique and strict adherence to the basic principles governing oral soft tissue grafting procedures. With an understanding of periodontal and peri-implant soft tissue anatomy and the principles of oral soft tissue grafting, the clinician can select, sequence, and successfully apply soft tissue grafting techniques to enhance functional and aesthetic results in implant therapy. Furthermore, cosmetic periodontal surgery can be used to create harmony between implant restorations and the remaining natural dentition.