Soft tissue manipulation around implants, papilla reconstruction : yesterday, today and tomorrow

Implant restorations in the anterior maxilla present unique aesthetic and surgical challenges, particularly when hard and soft tissue deficiencies are present. This webinar explores bone and soft tissue augmentation techniques that support predictable implant placement, papilla reconstruction, and long-term functional and aesthetic outcomes.

Implant restorations in the anterior maxilla are challenging, especially when treating patients with a high lip line and a lack of available tissue. These patients will exhibit large and unsightly dark embrasures reminiscent of severe gingival recession. The action of augmenting or regenerating soft tissue is more difficult to perform in the coronal direction than in other directions. Unfortunately, there is usually a need to replace lost tissue in the coronal dimension.

Bone is necessary to support a papilla and thus the height of any interdental papilla is related to the underlying bone level. So, in cases of severe bone loss, a bone graft should be performed prior to fixture installation for which autogenous bone graft is still the gold standard. Ridge anatomy can also be significantly improved by connective tissue grafts.

The use of a bone graft will allow the clinician to:

• Create a hard tissue support for implants and soft tissue/papillae.
• Optimise implant positioning.
• Optimise implant stability.
• Optimise papillae reconstruction.
• Optimise final aesthetics.

Tissue augmentation can therefore be related to several factors:

Ridge shape: The limit to the amount of augmentation possible is related not only to the amount of underlying bone but also to the quality of these tissues.

Quality of tissues: In the presence of scalloped/thin biotype, for example, augmentative connective tissue grafts may be performed to increase the amount of soft tissue available. In the presence of a flat/thick biotype soft tissue manipulation will be easier and the results more consistent.

Quantity of tissue (labial/palatal – labial/lingual): All patients have at least 5–7 mm thickness of soft tissue in the palatal region, whereas on the maxillary buccal side and all mandibular tissues, the average width is 2–3 mm.

The aforementioned surgical principles and techniques allow the clinician to obtain predictable, functional and aesthetically pleasing results when carefully applied.