Managing cases

The following steps should be taken to avoid the implant’s rough surface becoming exposed to the oral environment, as this can contribute to peri-implantitis:

• use a hybrid design with a machined neck
• leave enough width at the surrounding bone walls
• place the margin of the rough surface deep enough (1mm below crest)

Cases involving moderate atrophy can be approached in different ways:

• implant placement with simultaneous GBR in a submerged procedure
• ‘soft tissue approach for implant placement’ in a single surgery

Buccal dehiscence is usually caused by poor implant positioning and/or thin buccal tissues.

The preferred method for treating buccal dehiscence is considered to be soft tissue grafting (provided that there are no infrabony lesions). The alternative is implant extraction and starting again.

To prevent mucosal recessions in the future and achieve long-term stability of peri-implant tissues, the speakers highlighted two requirements:

• the buccal bone wall must be thicker than 1.5mm; if it is any less, the bone must be rebuilt
• stable margins; this can be done by thickening the connective tissue in the transmucosal area (3–4mm apical to the mucosal margin)