Soft Tissue Augmentation for Implant Dentistry

Soft Tissue Augmentation for Implant Dentistry
September 2003
Hartman, Gary A. DDS, MS
Implant Dentistry: Volume 12(3) September 2003 p 199
Lippincott Williams & Wilkins
Department of Periodontics
University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive
San Antonio, TX 78284-7894
Editors' Note: Please be aware that articles reviewed in this segment of Implant Dentistry are selected by the Editors and are assigned to be reviewed by knowledgeable individuals. These are not fillers. Each article has been carefully analyzed and diligently reviewed.
: David R. Cagna, DMD,* Scott R. Dyer, DMD,** Gary A. Hartman, DDS, MS,*** Robert M. Loughlin, DDS,ÇƒÜ; Michael P. Mills, DMD, MSÇƒ?;
Soft Tissue Augmentation for Implant Dentistry C. I. Evian, J. Al-Meseeh, E. Symeonides, Compendium, 2003;24:195-206
This article reviews the many various techniques for soft tissue augmentation for functional and esthetic reasons around implants in the anterior maxilla. The authors discussed the trends taking place in implant dentistry and describe the demand for optimal esthetics and the importance of the soft tissue profile around implant restorations. Thorough treatment planning of potential anterior implant cases should involve an evaluation of the patient's smileline and the amount of gingival display that is present. Any alterations of the gingival architecture of the existing dentition should be considered as part of the treatment plan to achieve a harmonious and acceptable appearance of the peri-implant supporting soft tissue.
A historical and descriptive synopsis of the various techniques for soft tissue augmentation is presented with clinical photos documenting the problem and the surgical solution. The free gingival graft technique is described historically as the precursor to today's soft tissue grafting armamentarium. Its predictability in achieving a band of keratinized tissue around dental implants is only inhibited by its ability to achieve an appropriate shade match with the surrounding soft tissues. The pouch procedure utilizing the subepithelial connective tissue graft offers superior esthetic results. The fact that the graft receives its blood supply from the periosteal bed and the overlying tissue makes it a predictable method of achieving increased thickness over implants that may be exposing through the thin alveolar mucosa. This is a common problem in the maxillary anterior because implants are oftentimes placed too facially owing to lack of bone to support the implant fixture. The authors also describe various flap procedures that reposition the soft tissue either apically or buccally to increase tissue around implants without the need for connective tissue. The roll technique first described by Abrahms, is explained in which the palatal portion of the flap is rolled under the flap to add thickness to the buccal tissues. The author mentions that each of these techniques are effective in various situations and that combinations of these can be used to enhance the augmentation procedures. Pictures of documented cases are shown for each of the various techniques.
The authors conclude with a summary of the challenges that face implant restorative dentists and surgeons with respect to superior anterior esthetics. Loss of papillae between implants and teeth is a common problem in implant dentistry. A combination of sound principles of implant positioning along with a good approach to soft tissue augmentation procedures can enhance the final restorative result and improve patient satisfaction.
¨© 2003 Lippincott Williams & Wilkins, Inc.