Despite the fact that osseointegrated implants can be maintained successfully on a long-term basis, the presence of peri-implant mucosal recessions may significantly affect the esthetic outcomes, patient satisfaction and, in certain cases, the biological and clinical stability. Increasing evidence suggests that the presence of an adequate width of attached mucosa (AM) may lead to increased soft and hard tissue stability, less plaque accumulation, less soft tissue recession and lower incidence of peri-implant mucositis. Therefore, an adequate width of stable (e.g. non-mobile) soft tissue appears to be essential to ensure long-term clinical stability. Additionally, the stability of pink esthetics around dental implant reconstructions has been strongly correlated with adequate peri-implant soft tissue thickness.
The etiology of peri-implant mucosal recessions may be related to various factors, such as the gingival phenotype (e.g. thick or thin), the presence of an insufficient width of attached/keratinized mucosa, the height and thickness of the facial or buccal bone wall, an oro-facial malposition of the implant, the angle of implant fixture, and the implant – abutment and prosthesis connection.
Scientific evidence and clinical data indicate that the use of the Modified Coronally Advanced Tunnel (MCAT) or the newly developed Laterally Closed Tunnel (LCT) in conjunction with connective tissue grafts alone or in combination with certain collagen based soft tissue replacement grafts may, in carefully selected cases, succesfully be applied for the treatment of mucosal recessions.
Peri-implantitis is characterized as an inflammatory reaction that affects the hard and soft tissues, which results in loss of supporting bone and pocket formation surrounding the functioning osseointegrated implant. Recent epidemiological data have provided evidence for a significant increase of in the prevalence of peri-implantitis amounting to a mean of 22%. As the number of implants placed per year continues to increase the development of appropriate treatment protocols for the treatment of peri-implantitis is becoming increasingly important for the clinician.
Based on the available literature and clinical experience, a treatment concept is proposed that may help the clinician to treat peri-implant mucositis and peri-implantitis.
Underlining the importance of soft tissues around dental implants, the presentation has the following learning objectives:
1. To discuss possible considerations for prevention of soft tissue complications in implant-related treatment planning.
2. To provide the rationale supporting the need of an adequate width of AM to maintain peri-implant health.
3. To provide the biologic rationale and treatment philosophy for the use of MCAT and LCT in soft tissue reconstructive surgery at dental implants.
4. To provide the clinician with a clinical concept on how the occurrence of peri-implant infections can be minimized, earlier diagnosed and treated.