Managing soft tissue "Aesthetic" complications

The so called "soft tissue" or "Aesthetic" complications are usually a sign of some underlying problem, anatomic limitations or the result of poor planning. Managing soft tissue problems around implants is much more sensitive than teeth, if the indications are there however, we can still achieve positive results with proper case selection and planning. Today we discuss a bit more on soft tissue problems and how to manage it when things go wrong :)

The most common non-plaque induced "soft-tissue" or "aesthetic" problems of implants:

  • Soft tissue recession
  • Loss of keratinised mucosa
  • Loss of inter-proximal tissue and scalloping ("papilla")
  • Thin "see-through" tissue and /or fenestrations
  • Scar tissue, color and pigmentation mismatch
Recession, lack of keratinised mucosa and other "mucogingival" problems can be often encountered around dental implants. Apart from aesthetic implications, such  complications might predispose to long term problems and inflammation. Whether to intervene surgically to correct or improve mucogingival conditions is not an easy decision and one needs to carefully assess the conditions, as often surgery runs the risk to deteriorate the problem. 

One of the most critical diagnostic decisions is to confirm that the problem is limited to or originates from the soft tissue and there is no underlying predisposition such as malposition of the implant or improper prosthetic design. If the soft tissue problem is "secondary", that means it is created from implant malposition or iatrogenic factors, surgical  intervention on the soft tissue without modifying the underlying problems might make things worse or fail to solve the problem. If the problem diagnosed is however based on the lack of soft tissue volume or  keratinised tissue, the Hybrid CT-Epithelial graft is one of the preferred methods of action, as it is minimally invasive,  ensures better healing conditions and can achieve both keratinisation and volume augmentation. 

As the actual technique might be difficult to fully comprehend by watching only clinical videos, today we have prepared for you a quick "explainer" video where you can see the full design of such a surgery. Then with a new eye, take a closer look how this is applied in the case of a peri-implantitis surgery! 
The most common causes of non-plaque induced "soft-tissue" or "aesthetic" problems of implants:

1. Compromised 3D implant position (mesiodistal, buccolingual, depth of placement)
2. Improper design of the Implant Supracrestal Complex
3. Insufficient provision for the establishment of 3-4 mm of vertical tissue  ("biologic width")
4. Overly invasive surgical intervention, improper surgical design, excessive tissue trauma
5. Improper patient selection, poor risk assessment
6. Failed augmentation procedures
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Puzzled with the incisions and sutures of the hybrid graft? This unreleased "explainer" video will help you understand the rationale and the process behind the design of this surgery!
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A "how to" video

to the whole process in action, visit the "how to" video of a clinical case  management with regeneration, implantoplasty and  CT-epithelial graft !

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Check out  Mastering Implant Complications! 
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