Treatment of peri-implant soft tissue defects: a narrative review.

Fausto Frizzera,Guilherme José Pimentel Lopes De Oliveira,Eloísa Boeck Marcantonio,Jamil Awad Shibli,Kely Cristina De Moraes,Elcio Marcantonio Junior

doi:10.1590/1807-3107bor-2019.vol33.0073

Abstract

Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional complaints. Treatments of these defects in implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. This narrative review discusses the proposed treatments for soft tissue defects around implants in the current literature. Several clinical and pre-clinical studies addressed methods to augment the quantity of the peri-implant keratinized mucosa. Autogenous grafts performed better than soft tissue substitutes in the treatment of soft tissue defects, but there is no clinical consensus on the more appropriate donor area for connective tissue grafts. Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla. Correction of peri-implant soft tissue defects may be challenging, especially in areas that exhibit larger defects and interproximal loss. Therefore, the regeneration of soft and hard tissues during implant treatment is important to prevent the occurrence of these alterations.

Highlights

Dental implants have been used for decades to treat tooth loss in several clinical situations.[1]
Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla
There is limited scientific evidence regarding the treatment of esthetic soft tissue defects in implants; prevention must be considered to avoid complications

Summary

Introduction

Dental implants have been used for decades to treat tooth loss in several clinical situations.[1]. An animal study that evaluated the treatment of peri-implant recessions with either CTG or a collagen matrix reported similar results in coverage.[42] The major issue about using first generation collagen matrices to treat soft tissues defects is the limited increase in tissue thickness.[9] New volume-stable collagen matrices were produced and are under investigation for dimensional stability in the long term. Evaluations of implants papillae were performed after second stage surgery and demonstrated an improvement in the papilla index score[47] after soft tissue manipulation and prosthetic rehabilitation.[52] In ridges that exhibited soft tissue deficiency, it was possible to stabilize a long and thick CTG over the facial and occlusal aspect (Figure 8) to increase tissue volume and height.[53] The graft should be submerged, and interproximal sutures may be used to coronally advance the papillae. The facial soft tissue moves coronally and may need a flapless crown-lengthening procedure to improve the esthetic outcome.[64]

Discussion

Findings

Conclusion