Revisiting implant controversies

Soft tissue complications around implants are more difficult than around teeth

For teeth, we have well established classifications, prognostic tools and treatment strategies supported by scientific evidence. For peri-implant soft-tissue recessions, however, these are not so well established. The differences between teeth and peri-implant mucosa and gingiva may lead to impaired treatment results. But extracting implants has psychological concerns for the patient, especially in the aesthetic area. Hence, we need to treat them.

Several factors, most of which are out of our control, have recently been found to have prognostic value for covering peri-implant soft tissue deficiencies (Decker et al., 2017). These factors may come from:

• patient-related factors: systemic conditions, diabetes, smoking, oral hygiene habits
• local conditions: inflammation, interproximal bone/soft tissue, implant buccal/lingual position, tissue thickness and keratinised tissue width

The prognostic factors should be assessed before treatment

The speaker shared several diverse clinical cases where the above patient-related and local factors were assessed as part of a check-list before treating the peri-implant soft-tissue defects (Decker et al., 2017).

First of all, they assessed whether the causal factor could be removed. Then, the general health and habits of the patient were evaluated. Turning next to the local conditions, they checked if there were any signs of inflammation, interproximal bone loss, the bucco-lingual position of the implant and the soft tissue dimensions.

It has been shown that a prosthetic-surgical approach (switching to a narrower abutment for a short length of time and then grafting with connective tissue) can achieve good clinical results (Zucchelli et al., 2018). However, it seems that case selection is crucial for treatment success. Nevertheless, the soft tissue approach should be always tried first, since it is often the case that the only alternative is to remove the implant. Soft tissue correction is also the first choice because it is the least invasive approach.

Nowadays, implant dentistry is focused on achieving optimal aesthetic outcomes and long‐term clinical stability. New techniques for managing soft tissue are available and could be the key to meet the increasing aesthetic demands from patients. Soft tissue augmentation around implants is a unique tool for ensuring long‐term functional and aesthetic stability.

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