Periodontal, Functional, and Esthetic Integration of Peri-Implant Soft Tissue: WHS Concept

Abstract

The long-term Functional success of the implant treatment depends on the stability of the crestal bone tissue around the implant platform. The Esthetic result is achieved by an adequate soft tissue in the peri-implant zone. Furthermore, the soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain for a long term, not only the implant osseointegration but also the integration of the soft tissue around the Sub and Supra-structure of the restoration. In order to create the protective soft tissue area, it is necessary to ensure three criteria. This treatment approach will be defined as the TWS – Soft Tissue Management : T for Thickness , W for Width, and S for Stability . The purpose of this article is to present with clinical cases, the detailed description of each criteria. There are many ways to achieve the two first criteria and they are well described in the literature. Achieving the third criteria of the Stability become possible only in the last years since the development of the digital technology and its implementation into the dental practice. A one time abutment and the creation of peri- implant mucosal thickness with an optimal amount of the attached keratinized gingiva above and around the implant platform, for muco-gingival integration of the system, are therefore a prerequisite for functional and esthetic result. The article presents the possibility for the clinicians to use in their daily practice this new clinical approach of TWS - Soft Tissue Management.

Digital Protocol of Dental Implantation With the Use of an Individual Bone Graft and the Creation of a Soft-Tissue Barrier

“…The lack of bone support led to the formation of a pronounced soft tissue defect of the alveolar process, which was accompanied by the absence of an attached keratinized gum (Figures 4, 5). In this regard, manipulations to create an attached gum zone were included in the treatment plan, since it is known that one of the conditions for the formation of a protective soft tissue barrier is the presence of a strip of attached gum in the periimplant area with a width of about 4 mm 10 .…”

Biological Response of the Peri-Implant Mucosa to Different Definitive Implant Rehabilitation Materials

“…Differences in the arrangement of collagen fibers around implants, with an orientation parallel to the implant abutment and less cellular and vascular proliferation, can negatively affect osseointegration and long-term implant stability. Prevascularized spheroids could improve this environment by providing a scaffold for cell growth and orientation, as well as promoting enhanced neoangiogenesis [ 13 ]. For example, if prevascularized spheroids are incorporated into the implant site, they could help establish a microvascular network in the tissue surrounding the implant abutment.…”

Immediate implant placement by using natural bovine bone substitute and acellular collagen matrix

“…Here a primary implant stability is crucial, however, the missing bone volume should be compensated by a bone grafting material [4]. Also, a sufficient soft tissue thickness is necessary for long-term success and stability [5]. Still, it remains a great challenge to achieve parallel success in new bone and soft tissue formation.…”