Conserving and Developing Soft Tissue Form Around Implants

After the period of pure osseointegration and function, a new era of implant dentistry has begun demanding aesthetic soft tissue outcomes. Incision technique, flap design and specific sutures are necessary for success. Surgery must be adapted to the individual situation of each patient depending on biotype and the quality of the soft tissue (Mucosa or Gingiva). These factors determine how we do aesthetic implant surgery today. Different tissues react differently to injuries and have individual patterns of healing.  Specific suturing techniques add to this phase of soft tissue predevelopment. Prosthetic design of the emergence profile must also be considered, as restorations around implants trigger different reactions and biologic responses than natural dentition. Design of the prosthetic components can lead to improved soft tissue aesthetics especially after bone graft procedures in the aesthetic zone.

In addition to surgical intervention, the creation of the specific emergence profile is essential in the aesthetic zone. The emergence profile is composed of two parts: the abutment and the subgingival part of the crown. Individually shaped custom abutments can provide a natural appearance and address the depth, angulation and diameter of the implant. Sometimes it even dictates the implant position. From a surgical perspective, soft tissue height, position and thickness need to be diagnosed and corrected when needed. From the prosthetic point of view, the emergence profile must be created to mimic the natural appearance and maintained over time in respect to biological changes.

The main purpose of this lecture is to explain, demonstrate and teach soft tissue development around implants in fixed single and multiple implant placement. Clinicians will learn considerations in building treatment plans based on individual circumstances, and how to utilize modern prosthetic technology for reconstruction of soft tissue for single and multiple implants.