Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series.

Abstract

Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion. Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale. The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points. The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.