Abstract
A minimal width and thickness of keratinized and attached soft tissue is desirable to prevent peri-implant diseases. This report describes the preliminary results of a pilot study of a surgical approach for soft tissue augmentation around loaded dental implants in the partially or totally edentulous maxilla. Four patients presenting eight maxillary implants with a buccal peri-implant soft tissue deficiency received a laterally rotated flap. A buccal mesial and apical recipient area was created around each implant, and a pediculated keratinized graft was rotated 90° from the distopalatal and positioned and sutured on the peri-implant buccal aspect. All implants treated showed a gain in buccal clinical peri-implant attachment (1.37 ± 0.44 mm) and buccal soft tissue levels (2.06 ± 1.40 mm) and interproximal soft tissue levels (1 ± 0.75 mm). The technique provided quality soft tissue with a gain in soft tissue thickness (3.06 ± 0.68 mm) and keratinized wide tissue (4.69 ± 0.80 mm) with minimal morbidity (1575 ± 549.67 mg of ibuprofen) and maintenance of prosthetic loading. Peri-implant soft tissue stability was maintained for 13.5 ± 1.87 months. Laterally rotated flap can be applied and provide clinical benefits to compromised implants due to the presence of buccal peri-implant soft tissue deficiency. Further studies are required to confirm these preliminary results.
Highlights
Peri-implant mucositis is one of the most common peri-implant diseases
A significant association was found between peri-implant mucositis, and smoking, implant maintenance, and periimplant soft tissue characteristics [3]
The inclusion criteria were (1) patients with partial or complete maxillary implant rehabilitation, (2) buccal soft tissue deficiency in an osseointegrated implant [16], (3) buccal hard tissue dehiscence on the implant and buccal transparency of the underlying implant surface, (4) plaque and bleeding index of < 30%, and (5) non-plaqueretained prosthetic design; if absent, the restoration was changed to a crown with a physiologic emergence profile [20]
Summary
Peri-implant mucositis is one of the most common peri-implant diseases. It was reported in more than 20% of subjects rehabilitated with dental implants [1,2,3]. A significant association was found between peri-implant mucositis, and smoking, implant maintenance, and periimplant soft tissue characteristics [3]. Soft tissue quality and volume of the peri-implant mucosa are considered important factors in the prognosis of osseointegrated implants. Linkevicius et al [4] showed that if the soft tissue thickness was less than 2 mm, crestal bone loss might occur.
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