Soft Tissue Augmentation Procedures for Mucogingival Defects in Esthetic Sites

Abstract

This systematic review was performed to address the focus question: "In adult patients with soft tissue deficiencies around maxillary anterior implants, what is the effect on esthetic outcomes when a soft tissue procedure is performed?" In addition, this paper reviews the importance of presurgical esthetic risk assessment (ERA) starting with comprehensive team case planning prior to surgical intervention and a restorative-driven approach. Materials and Methods: A thorough Medline database search performed on related MeSH terms yielded 1,532 titles and selected abstracts that were independently screened. Out of the 351 abstracts selected, 123 full-text articles were obtained for further evaluation. At each level, any disagreements were discussed until a consensus was reached. Results: A total of 18 studies were included in this systematic review of esthetic outcomes following soft tissue procedures around implants with soft tissue deficiencies. A preliminary analysis of the included studies showed that the vast majority were case series studies with most not providing objective outcomes of their results. Moreover, only one randomized controlled trial was identified. Therefore, quantitative data analysis and subsequent meta-analysis could not be performed. The included studies were grouped according to the intervention on the peri-implant soft tissue performed and six groups were identified. The periodontal procedures performed around dental implants gave initial good results from the inflammation involved in wound healing, but in virtually all cases significant recession occurred as healing resolved and the tissues matured. Conclusions: Although success of implant therapy is similar in the anterior maxilla and other areas of the mouth, the majority of studies evaluating this therapy in the esthetic zone are lacking literature support, few in number, devoid of long-term follow-up and number of patients, and are subject to inclusion bias. The use of the ERA tool for all esthetic zone cases can benefit both the clinician and the patient to avoid any miscommunication and problems of expectation upon completion. All the available knowledge on this topic, including the approaches described in this paper, is based on a very limited literature support and thus should be addressed with caution. These concerns should encourage long-term good clinical trials for better assessment of those issues. Int J Oral

The Role of Keratinized Mucosa to Maintain the Peri-Implant Health: A Case Report after Five Years Follow-Up

“…However, this technique is indicated only for the defect of mild severity due to limited supply of donor tissue [1]. The goal of the treatment in the present case was to increase buccal soft tissue thickness to mask the implant and to make oral hygiene easier for the patient [10].…”

“…The results of this study are consistent with a cross sectional study by Bouri et al [4] that reported that increased width of keratinized mucosa (≥ 2 mm) around implants is associated with lower mean alveolar bone loss and improved indices of soft tissue health. Wider zones of keratinized mucosa may lead to more resistance to the forces of mastication and frictional contact that occur during oral hygiene procedures [4] Levine et al [1] concluded in their systematic review that for some patients a lack of keratinized mucosa may be a risk factor for one or more issues: plaque accumulation, tissue soreness while brushing, gingival inflammation, recession, bone loss, and esthetics. Regarding esthetics in the anterior maxilla, Zigdon and Machtei [5] reported in their retrospective clinical trial that the keratinized mucosa thickness and width around dental implants affects both the clinical and the immunological parameters at these sites.…”

“…Numerous studies have examined the relationship between the width of keratinized mucosa and the health of peri-implant tissues [1]. The necessity of the presence of keratinized mucosa around dental implants continues to be controversial [1][2][3][4][5][6]. However, an increase in the width of keratinized tissue may be considered in order to simplify patient's oral hygiene and to maintain the mucosal tissue level [1].…”

Peri-implant mucosal dehiscence coverage with a modified semilunar coronary positioned flap in posterior maxilla: a case report

“…This phenomenon not only causes an esthetic disturbance in the anterior region but it may also lead to poor oral hygiene in the posterior region, because molar teeth exhibit contours with prominent convexities leading to accumulation of plaque. A few clinical articles on mucosal dehiscence coverage around dental implant have been published [1, 2]. Of these, only one study has been randomized controlled [3], whereas the other has been either a small a series of cases or a case report related to recession around a single implant.…”

“…Of these, only one study has been randomized controlled [3], whereas the other has been either a small a series of cases or a case report related to recession around a single implant. A literature review and a conference paper cited that dehiscence coverage around dental implant is technique-sensitive [1, 2]. Although no recommendation can be made to support the selection of one technique over another [1, 2], coronary positioned flap (CPF) with sub-epithelial connective tissue graft (SCTG) is considered to be a major treatment option.…”