Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-03-24, 17:16:09 | version 1.38.0
research | 1 2016 implants 23 an anatomical gingival architecture while, as a first step, creating two vestibular neo-papillae (Fig. 28). After separating the sections, the pal atal tissue (finger) is divided into two to make two palatal half-papillae, joined one on one with their vestibular counterparts (Fig. 29); –– where there is a combined deficit, the same in cisions are combined with a buried connective vestibular graft. Provided that there is sufficient volume, the graft is taken from the maxillary tu berosity, since this area has the advantage of providing graft tissue that is more dense, opaque and less adipose than the palate and, in addition, results in less postoperative pain. If the graft is transferred in a V- or Y-shape, it can support the newly formed papillae. The shape of the palatal incision can be modified to a Y-shape to assist rotation of the palatal half-papillae (Fig. 31). If the thickness of the buccal gingival tissues has not been augmented or if collagen substitutes are used that do not have the opacity characteristics of tuberosity connective tissue, the aesthetic out come can be compromised. If there is recession of the external table or the titanium abutment under thin connective tissue, the grey titanium colour can be seen through the gum as a grey halo above the crown collar, which is detrimental to the aes thetic appearance (Figs. 32 & 33). “Systematicallyaugment thethicknessofbuccal connectivetissue.” Conclusion The aesthetic fundamentals for an implant are in the preprosthetic surgical stages of the treatment. Any approximation in the location of the implant in such a narrow implant corridor, any lack of sup port for papillae or any deficiency in the thickness of hard or soft tissues, will result in aesthetic prob lems. The prosthetic stages allow optimisation of the result as regards the gingival context but any error in the surgical stage will often be impossible to correct during the prosthetic stages. For this reason it is vital to approach this first part of the implant treatment for a lateral incisor with thor oughness and precision._ Editorial note: A list of references is available from the publisher. This article was originally published in the Éditions CdPprostheticjournal,No167,September2014and the Clinical Masters Magazine No 1/2015. Fig. 31: Insertion of connective graft buried under the papillae. Fig. 32: Clinical outcome in a case of gummy smile. Fig. 33: Insufficient soft tissue thickness alters the chromatic outcome. contact Dr Philippe Russe, former assistant at the Reims University and Hospital. He runs his private practice in Reims, France. Dr Patrick Limbour, MCU-PH, Head of department of oral surgery, Pontchaillou University Hospital, Rennes, France. Fig. 31 Fig. 32 Fig. 33 12016