Mario Roccuzzo - Peri‑Implant Soft‑Tissue Integration and Management

(periodontology, implantology, oral surgery)

Via Giuseppe Posca 15

70124 Bari (BA)

Italy

raffaelecavalcanti@gmail.com

Nikolaos Donos

DDS, MS, FHEA, FDSRC, PhD

Professor, Head and Chair, Periodontology and Implant Dentistry

Head of Clinical Research

Institute of Dentistry, Barts and The London School of Medicine and Dentistry Queen Mary University of London

Turner Street

London E1 2AD

United Kingdom

n.donos@qmul.ac.uk

Daniel Etienne

Dr chir dent, MSc

Private practice

1, Avenue Bugeaud

75116 Paris

France

etienne@paro-implant.com

Jason R Gillespie

BS DDS MS

Private prac:ce (Prosthodon:cs)

105 W El Prado Dr

San Antonio, TX 78212-2024

United States of America

jason@gillespie.dental

Alfonso Gil

DDS, MS, PhD

Resident Physician

Clinic of Reconstructive Dentistry

Center of Dental Medicine

University of Zurich

Plattenstrasse 11

8032 Zurich

Switzerland

alfonso.gil@zzm.uzh.ch

Christoph Hämmerle

Professor, Dr med dent, Dr h c

Chair

Clinic of Reconstructive Dentistry

Center of Dental Medicine

University of Zurich

Plattenstrasse 11

8032 Zurich

Switzerland

christoph.hammerle@zzm.uzh.ch

Vincenzo Iorio-Siciliano

DDS, MS, PhD

Department of Periodontology

University of Naples Federico II

Via Sergio Pansini 5

80131 Napoli (NA)

Italy

enzois@libero.it

Ronald Jung

Professor, Dr med dent, PhD

Head, Oral Implantology

Clinic of Reconstructive Dentistry

Center of Dental Medicine

University of Zurich

Plattenstrasse 11

8032 Zurich

Switzerland

ronald.jung@zzm.uzh.ch

Eduardo Lorenzana

DDS, MSc

Private practice (periodontology)

3519 Paesano’s Parkway

Suite 103

San Antonio, TX 78231-1266

United States of America

drlorenzana@yahoo.com

Neil MacBeth

BDS, MFGDP, MGDS RCS, MFDS RCS, FFGDP (UK), MSc, FDS RCS (Rest Dent), CDLM, RAF

Consultant in Restorative Dentistry – Defence Primary Health Care

Clinical Senior Lecturer in Periodontology

Institute of Dentistry, Queen Mary University of London

Institute of Dentistry, Barts and The London School of Medicine and Dentistry

Turner Street

London E1 2AD

United Kingdom

n.d.macbeth@qmul.ac.uk

Kurt Riewe

DDS

Private practice, Stone Oak Dental

335 E Sonterra Blvd

Suite 150

San Antonio, TX 78258-4295

United States of America

kurt.riewe@gmail.com

Shakeel Shahdad

BDS, MMedSc, FDS RCSEd, FDS (Rest. Dent.) RCSEd, DDS, FDT FEd

Consultant in Restorative Dentistry

Barts Health NHS Trust

The Royal London Dental Hospital

and

Honorary Clinical Professor in Oral Rehabilitation and Implantology

Barts and The London School of Medicine and Dentistry

Queen Mary University of London

Turner Street

London, E1 1DE

United Kingdom

shakeel.shahdad@nhs.net

Daniel Thoma

Professor, Dr med dent

Vice-Chairman

Head, Reconstructive Dentistry

Clinic of Reconstructive Dentistry

Center of Dental Medicine

Vice Chairman, Center for Dental Medicine

University of Zurich

Plattenstrasse 11

8032 Zurich

Switzerland

daniel.thoma@zzm.uzh.ch

Pietro Venezia

DDS

Adjunct Professor

Department of Prosthodontics

University of Catania (Italy)

and

Private practice

Via G. Posca, 15

70124 Bari (BA)

Italy

pierovenezia@gmail.com

Table of Contents

1 Introduction

M. Roccuzzo

2 Importance of the Peri-Implant Soft Tissues

A. Sculean

3 Soft-Tissue Management around Tissue-Level Implants

M. Roccuzzo

3.1 Soft-Tissue Management at Implant Placement

3.2 Soft-Tissue Management Before Implant Placement

3.3 Soft-Tissue Management During Supportive Care

4 Soft-Tissue Grafting After Implant Placement

M. Roccuzzo, A. Sculean

4.1 Increasing the Width of the Keratinized Mucosa

M. Roccuzzo

4.2 Soft-tissue Replacement Materials

A. Sculean

5 Peri-Implant Soft-Tissue Dehiscences

5.1 Indications for Peri-Implant Soft-Tissue Dehiscence Coverage

M. Roccuzzo

5.2 Techniques for Treating Peri-Implant Soft-Tissue Dehiscences

M. Roccuzzo

5.2.1 Tunneling Technique for Treating Peri-Implant Soft-Tissue Dehiscences

A. Sculean

6 Clinical Case Presentations

6.1 Implant Placement in the Esthetic Zone and Coverage of Multiple Gingival Recessions

S. Aroca

6.2 Periodontal Plastic Surgery and Prosthetic Procedures to Treat Peri-Implant Soft-Tissue Dehiscences

P. Casentini

6.3 GBR and Soft-Tissue Augmentation Following Explantation to Rehabilitate a Soft- and Hard-Tissue Defect

R. Cavalcanti, P. Venezia

6.4 Soft-Tissue Volume Augmentation Using a Connective-Tissue Graft Harvested from the Maxillary Tuberosity

D. Etienne

6.5 Connective-Tissue Graft to Increase the Width of the Keratinized Mucosa Around an Osseointegrated Implant

V. Iorio-Siciliano

6.6 Soft- and Hard-Tissue Regeneration and Implant-Supported Restorations to Treat a Complex Anterior Maxillary Case

R. Jung, A. Gil, C. Hämmerle, D. Thoma

6.7 Early Implant Placement, Contour Augmentation, and Autologous Connective-Tissue Graft Using a Tunneling Technique to Replace an Upper Incisor with Generalized Gingival Recession

E. Lorenzana, J. Gillespie

6.8 Connective-Tissue Graft to Augment the Buccal Tissue for a Bone-Level Implant at an Upper Incisor Site

E. Lorenzana, K. Riewe

6.9 Treatment of a Soft-Tissue Fenestration in the Esthetic Zone

N. MacBeth, N. Donos

6.10 Covering a Soft-Tissue Dehiscence at a Mandibular Incisor

M. Roccuzzo

6.11 Soft-Tissue Augmentation Using a Porcine-Derived Collagen Matrix to Correct a Labial Soft-Tissue Defect Following Extraction of a Maxillary Incisor

S. Shahdad

7 Conclusions

M. Roccuzzo

8 References

1 Introduction

M. Roccuzzo

In the earlier days of implant dentistry, osseointegration was considered to be a sufficient condition for long-term successful implant rehabilitation. With time, however, it became evident that soft-tissue integration is of significant importance and that the formation of an early and long-standing effective mucosal barrier, capable of biologically protecting the peri-implant structures, is essential. This soft-tissue barrier is mainly the result of a wound-healing process that results in an effective interface between “living tissues” and a “foreign body” (Rompen and coworkers 2006).

Whether the presence of a minimum amount of keratinized mucosal (KM) is necessary for the long-term maintenance of peri-implant health has been controversial for many years. Several researchers have found that insufficient KM may be correlated with plaque accumulation, bleeding on probing, discomfort when brushing, mucosal recession, and peri-implant mucositis (Bouri and coworkers 2008; Boynueğri and coworkers 2013; Chung and coworkers 2006; Roccuzzo and coworkers 2016). Other researchers were unable to obtain similar findings (Frisch and coworkers 2015), with some even suggesting that KM may not be essential in the presence of scrupulous oral hygiene and rigorous compliance with a professional maintenance regimen (Lim and coworkers 2019).

On the other hand, complete osseointegration and perfect soft-tissue integration are not necessarily correlated with successful esthetic rehabilitation of a missing tooth or teeth. Indeed, success criteria for esthetically sensitive areas must include measurements of the peri-implant mucosa, as well as the restoration and its relationship to the surrounding dentition (Belser and coworkers 2004).