EAO video stream
Reconstructive periodontal-plastic surgery around implant in combination with doubled-folded connective tissue graft and submarginal incisions
The speaker presented a case involving a peri-implant soft tissue dehiscence around the right upper central incisor. The treatment plan was threefold:
- Save the compromised implant
- Increase peri-implant mucosal thickness
- Improve aesthetics
In the first step, the prosthetic component was removed. A new, thinner abutment was placed without the crown. This procedure has been shown to result in better coverage (Burkhardt et al. 2008; Zucchelli et al. 2012). The second step involved multiple coronally advanced flaps after four weeks. According to Zucchelli et al. (2009), this technique compares favourably in terms of the aesthetic outcome with those approaches involving vertical releasing incisions.
“This procedure has been shown to result in better coverage”
The connective tissue graft (CTG) – regardless of its source – should be a dense tissue, rich in fibres and with as little glands or fat as possible (Studer et al. 1997; Zucchelli et al. 2010; Dellavia et al. 2014). Before detaching the graft from the palatal mucosa, the epithelium was removed. The graft was then double-folded before adapting it to the recipient site.
Before the definitive crown in was installed at 11, the left central incisor had to be extracted and an immediate implant was placed. Finally, two cemented crowns were placed at 11 and 21 and two laminate veneers at 12 and 22.
When an implant is poorly placed, a decision must be made whether to improve aesthetics by soft tissue augmentation or to remove the implant and start again from the beginning.