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Do you need to increase your focus on surgical soft tissue management and grafting?

Establishing an adequate band of attached tissues, to resist mechanical and biologic challenges, is so critical that a primary educational focus of dental implant surgeons has become learning surgical techniques for the management of peri-implant tissues for predictable, best results.


THE REASONS

There are three reasons why dental implant surgeons need a well-developed knowledge base and skills in the area of surgical soft tissue management and grafting.

1) In order to be functionally successful, a dental implant must integrate with healthy connective tissue and epithelium, as well as with healthy bone.

2) In order to be esthetically successful, the soft tissue surrounding a dental implant must be healthy and natural in appearance.

3) In order to be biologically successful, the soft tissue must form a seal that protects the implant by resisting the invasion of bacterial irritants. Healthy, immobile, peri-implant soft tissues also resist mechanical trauma, facilitating restorative procedures and good patient hygiene.


THE GOALS

The goals of surgical management of peri-implant soft tissues are to:

1) Create a stable peri-implant soft-tissue environment by providing adequate width and thickness of attached (immobile) soft tissues, preferably keratinized, that are precisely adapted to the transmucosal portions of the implant.

2) Reconstruct natural soft tissue architecture and a pleasing gingival appearance around natural dentition and implant restorations.


CREATING A STABLE PERI-IMPLANT SOFT TISSUE ENVIRONMENT

Careful manipulation and preservation of soft tissues before and during implant surgery will yield optimal long-term results, but only if there is sufficient good quality soft tissue.When soft tissue quality or volume is insufficient, adjunctive oral soft-tissue grafting can be used to reconstruct the missing tissue. In general, oral soft tissue grafting techniques are classified into “free grafts” and pedicle flap techniques. The most commonly used “free graft” techniques include:

  • Epithelialized palatal mucosal grafts (gingival grafts)
  • Subepithelial connective tissue grafts
  • Combination onlay-interpositional grafts
  • The alternative use of “soft tissue graft substitutes” supported by evidence based studies such as MucoGraft ™ which has demonstrated similar results to for root coverage and gains in keratinized tissue at grafted sites when compared to subepithelial connective tissue grafts

Pedicle flap procedures are used at maxillary anterior pontic and implant sites, and include:

  • The palatal roll procedure for small soft tissue reconstruction
  • The VIP-CT flap technique for large soft tissue reconstruction  and simultaneous soft and hard tissue esthetic implant site development


RECONSTRUCTING NATURAL SOFT TISSUE ARCHITECTURE AND ESTHETICS

One, more or all of the following therapies are often indicated in order to optimize esthetics in implant therapy:

  • Soft tissue implant site development (soft tissue grafting)
  • Bone ridge augmentation
  • Root or abutment coverage (soft tissue grafting)
  • Esthetic crown lengthening


NOTE:
 The Sclar Center offers courses that are designed to provide the exact patient evaluation, case planning, and peri-implant site development and plastic surgery training needed to successfully manage soft tissue around dental implants for biological, functional and esthetic success. I personally teach these courses and guide students in performing the surgical procedures. When you learn the preoperative considerations, instrumentation, techniques, and post-operative considerations for the listed procedures, keep in mind that your surgical assistant should also become familiar with the principles of oral soft tissue grafting, instrumentation, surgical techniques and postoperative considerations. That’s why we offer a parallel course for your surgical assistant while you are attending a course with us. I feel empowering and training your surgical assistant are so important to successful implementation that your doctor’s tuition fee covers your assistant, as well.

 

4 Comments

  1. May 1, 2012

    Nice article Dr. Sclar. Congrats for your fantastic web page. I agree with you that in nowadays every dentist should know how to manage peri implant soft tissue and to know the limitations although the literature that we have till now is not enough in my point of view.

  2. May 20, 2012

    Dear Dr. Sclar, lovely article and extremely nice and informative web site.
    It can only help to enrich our knowledge about dental implants and improve our practice all over the world.
    I look forward to reading more of your work.

  3. August 7, 2012

    Very interesting article!
    I think soft tissue management is the key for success in implant dentistry.

  4. February 10, 2013

    I actually think that posting, “Do you need to increase your focus on surgical soft tissue management and
    grafting? | dentalimplantstrategies.com” ended up being just right! I personally couldn’t see eye to eye with you more! At last, it seems like I discovered a blog website worthy of reading. I appreciate it. Myles

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