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soft tissue enhancement around a dental implant crown |
At the beginning of the dental implants era, we thought that just placing the dental implant on a prosthetically convenient place and achieving a proper osseointegration was already a success. Today the success criteriahave been raised in the dental implantology, based on the continuous research.
How soft tissue protects the implant
The amount and quality of the gingival soft tissue around the dental implant neck is one of those success criteriabeing considered nowadays in dental implatology
- The free gingiva is made of non keratinized tissue. It surrounds the neck of teeth and implants and its inner side forms the gingival sulcus.
- The attached gingival tissue is made of keratinized fibers and it is associated to masticatory function. It lays between the alveolar mucosa and the gingival groove. It has a characteristic orange-peel stipplings in a healthy state.
- The alveolar mucosa is the non keratinized continuation of the attached gingiva towards the cheeks and lips. It is movable, too. Between this two there is a characteristic line, limiting what is attached and what is movable.
Clinical soft tissue management case
In this clinical case we see how two dental implants are placed on the left lower jaw, after a long term period without teeth. 50 year-old woman, non smoker, thick biotype.
Diagnose
By clinical examination we appreciate light vertical bone resorption, mid horizontal resorption -thanks to the thick biotype pattern- but indeed a remarkable recession of the attached gingiva. The mesio-distal gap between adjacent teeth is 23mm.
The 5″ diameter measurement balls show panoramic 2D X-ray show enough bone depth for two 12,5″ ICX-Templant implants on both sides. We will discuss the left side on this post only.
Implant surgery
Incision
Contrary to a normal implant surgery, where the upper incision is done right on the ridge, in this case we want to displace as much keratinized epithelium from the lingual side and fix it bucally. we need also two vertical discharges along which the flap will be moved.
Implant placement
Suture of the flap
Now it is time to screw the healing abutments (3″ hight in this case) and to reposition the flap bucally with 6/0 Prolene stitches on the periosteum.
Removing the suture stitches
The gum tissue needs now quite a few week to re-epithelize the area, while the implants complete the osseointegration phase. The stitches can be removed one or two weeks after the surgery, but in this it was done 4 weeks later, because the patient leaves a few hours away from the office and cannot come so easily. I try to adapt the appointments to other work stages on the right side, ceramic inlays and other conservative general dentistry therapies.
At this stage an enhancement of the attached gingiva can already be seen buccally.
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