Abstract

The peri-implant soft tissue (PIS) augmentation procedure has become an integral part of implant-prosthetic rehabilitation. Minimal width of keratinized mucosa (KM) of 2 mm is deemed necessary to facilitate oral hygiene maintenance around the implant and provide hard and soft peri-implant tissue stability. PIS thickness of at least 2 mm is recommended to achieve the esthetic appearance and prevent recessions around implant prosthetic rehabilitation. The autogenous soft tissue grafts can be divided into two groups based on their histological composition—free gingival graft (FGG) and connective tissue graft (CTG). FGG graft is used mainly to increase the width of keratinized mucosa while CTG augment the thickness of PIS. Both grafts are harvested from the same anatomical region—the palate. Alternatively, they can be harvested from the maxillary tuberosity. Soft tissue grafts can be also harvested as pedicle grafts, in case when the soft tissue graft remains attached to the donor site by one side preserving the blood supply from the donor region. Clinically this will result in less shrinkage of the graft postoperatively, improving the outcome of the augmentation procedure. To bypass the drawback connected with FGG or CTG harvesting, substitutional soft tissue grafts have been developed.

Highlights

  • Peri-implant soft tissue (PST) thickness and width of keratinized mucosa (KM) have a major impact on the esthetic appearance, stability, and health of implant/ prosthetic reconstruction

  • In patients with a flat palate, the palatine artery is closer to the CEJ, located 7 mm apically of the CEJ of adjacent teeth resulting in a limited height of the connective tissue graft (CTG) [25, 26, 57–60]

  • The results of peri-implant soft tissue (PIS) grafting with substitutional grafts, at the present are inferior to the results obtained after autogenous soft tissue grafting [5, 8, 65, 66, 93, 99], the absence of the donor site makes this treatment modality appealing to the patient and practitioners, as well [26, 42, 100]

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Summary

Introduction

Peri-implant soft tissue (PST) thickness and width of keratinized mucosa (KM) have a major impact on the esthetic appearance, stability, and health of implant/ prosthetic reconstruction. The success of implant treatment was based on implant survival rates, prosthetic stability, radiographic bone loss, and absence of infection [2, 3]. They have shifted from healthy and functional to healthy, functional, esthetic, and natural-looking tooth replacement [4]. The PST augmentation procedure became a fundamental part of implant treatment algorithms. There are two main objectives of soft tissue augmentation around implants—(1) to restore an adequate width of KM and (2) to increase the volume of peri-implant soft tissue [5]

KM width around implants
Esthetic appearance
General principles of PIS grafting
Connective tissue graft harvesting (CTG)
The role of the primary flap
Donor area
Surgical technique
Connective tissue pedicle flaps
Preparation of recipient site for CTG
Recipient site preparation
Donor site preparation
Alternative sites for free autogenous graft harvesting-maxillary tuberosity
Substitutional soft tissue grafts
Findings
Conclusion

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