Program

The recession of the buccal soft tissue margin is a frequent complication of well integrated dental implants. The appearance of metallic structure or even their transparency through the thin buccal soft tissues are common reasons for patient aesthetic complains. Moreover, bad implant installation frequently results in excessive apical dislocation of the buccal soft tissue margin of the implant supported crown. Soft tissue plastic surgical procedures and bilaminar techniques in particular, can be successfully used in combination with a pre and postsurgical prostethic approaches to increase the volume of the interdental soft tissue, to treat buccal gingival recessions and soft tissue dehiscence around dental implants and to provide the new implant supported crown with an esthetic transmucosal emergency profile. A new mucogingival approach applied to delayed or immediate post-extraction implant placement and loading will be presented.

Soft tissue plastic approaches to increase the height of the keratinized mucosa and / or the thickness of the peri-implant soft tissues can be performed at three different stages: before implant placement, simultaneously with implant placement and after implant placement.

After implant insertion, specially in the mandible, it is frequent to face clinical scenarios in which there is complete absence or a minimal quantity of keratinized tissue, many of the times associated with a reduced depth of the vestibular fornix and a coronal muscle insertion. In these cases, where there are no esthetic demands, the main objective is to reconstruct/increase the quantity of keratinized mucosa and deepen the vestibule so as to facilitate the performance of oral hygiene by the patient and at the same time reduce the risk of soft tissue dehiscence . The most appropriate surgical technique to obtain those results is the free gingival graft.

Most of the times soft tissue deficiencies at the buccal aspect of implant-supported crowns are a matter of thickness rather than height. The lack of adequate thickness of the buccal soft tissues can lead to incorrect emergence profiles of the prosthetic crown, which are difficult to maintain from a hygienic point of view; in these cases, the main goal of the plastic surgery is not to increase the height of the keratinized tissues but to augment the thickness of the connective tissue at the level of the peri-implant transmucosal portion. This is achieved with a surgical technique that involves the use of a connective tissue graft covered by a coronally advanced flap.

Learning objectives

1. Describe step by step the free gingival graft procedure to increase keratinised mucosa height before or after implant placement
2. Describe the surgical procedure combining  transmucosal implant placement and simoultaneous submarginal  connective tissue graft or collagen matrix
3. Describe step by step harvesting technique