Peri-implant soft tissues management

OBJECTIVES The objective of this Module is to describe, based on the most recent literature, the management of peri-implant soft tissues in order to guide the clinicians in the decision of the surgical technique to adopt in daily practice. The height of the peri-implant supracrestal soft tissue (TSP) is defined as the vertical dimension of the soft tissue from mucosal margin to the crestal bone. The term keratinized tissue (KT) defines the external characteristic of the portion of soft tissue measured as vertical distance from the mucosal margin to the mucogingival line. The thickness of the peri-implant soft tissues is not related to the height of the keratinized tissue and is measured as the horizontal dimension of the soft tissues between the external surface of the mucosa and the hard metal surface of the implant-prosthetic component. The soft tissue thickness is closely related to the concept of tissue phenotype as it depends primarily on the connective tissue thickness between the external oral epithelium and the sulcular epithelium MATERIALS AND METHODS Surgical techniques have been divided into: techniques for increasing the thickness of peri-implant soft tissues and techniques for increasing keratinized tissue RESULTS The various therapeutic approaches have been described step by step through a series of clinical cases. In the posterior areas the free gingival graft is indicated to increase the keratinized tissue and therefore improve the self-performed plaque control. In the anterior areas during implant placement, the adjunctive use of a connective tissue graft improve the aesthetic result of the final implant-supported restoration. In the treatment of aesthetic complications, the combined prosthetic-surgical approach has shown excellent results in terms of complete dehiscence coverage. CONCLUSIONS Management of peri-implant soft tissues plays a crucial role, in terms of function and esthetic, in the implant supported crown rehabilitation. CLINICAL SIGNIFICANCE An optimal implant-prosthetic rehabilitation must be performed through a careful evaluation of the clinical conditions of hard and soft tissues. The insertion of the implant in an adequate amount of bone in height and thickness is the prerequisite for osseointegration and functional stability over time. The management of peri-implant soft tissues guarantees the maintenance of a good oral hygiene control and allows to guarantee a satisfactory aesthetic result.