Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-14, 10:36:46 | version 1.38.0
I C.E. article_ labial soft-tissue recession Management of midfacial recession defects around adjacent maxillary implants using ‘screw tent-pole’ technique Author_Bach Le, DDS, MD, FICD, FACD _c.e. credit This article qualifies for C.E. credit. To take the C.E. quiz, log on to www. dtstudyclub.com. Click on ‘C.E. articles’ and search for this edition (Im- plants C.E. Magazine — 1/2018). If you are not registered with the site, you will be asked to do so before taking the quiz. _Soft-tissue recession around dental implants often results in metal exposure and can pre- sent a major esthetic challenge.1,2,3 Unfortunately, soft-tissue recessions around implants have been frequently observed,4 with one study reporting mid- facial recessions greater than 1 mm were present in 61 percent of the cases.5 Treatment and coverage of periimplant soft-tissue recessions can be challeng- ing despite reports in the literature indicating that recessions up to 2 mm can be successfully grafted with a combination of coronally advanced flap and subepithelial connective tissue grafts.1,3 Long-term data on the success of these grafting techniques is limited.3, 6-7 Thoma, et al, conducted a systematic review8 and reported that the combination of an apically positioned flap/vestibuloplasty and soft-tissue aug- mentation using a free gingival graft, subepithelial connective tissue graft or collagen matrix resulted in a 1.4-3.3 mm increase in keratinized tissue. Overall, soft-tissue connective tissue augmentation resulted in the best gains in soft-tissue volume at implant and partially edentulous sites, and a combination of bet- ter papilla fill and higher marginal mucosal levels as compared to non-grafted sites around immediately placed dental implants.8 A recent systemic review9 did not find a single acceptable randomized clinical triall (RCT) in the world literature to recommend the best incision designs, suturing techniques or materi- als to correct or augment periimplant soft tissues. One of the aim of soft-tissue augmentation procedures is to correct mucosal recession. To ad- dress bone loss and associated gingival recession around implants in the esthetic zone, a combination of guided bone regeneration (GBR)10 and soft-tissue augmentation11 are often performed. When multiple implants are placed in the esthetic zone, vertical and horizontal bone augmentation of more than 2 mm from the implant platform is often necessary to overcome the normal pattern of bone remodeling and soft-tissue recession.12 The use of coronally advanced flaps and connective tissue grafts can sometimes jeopardize the esthetic appearance of the treatment site by altering the color and thickness of the transplanted tissues.13 The use of a particulate mineralized bone al- lograft covered with a collagen membrane (GBR) for the correction of gingival recession has been reported in the dental literature by Le, et al.14 This case report demonstrates an innovative surgical technique to restore hard tissue and increase mu- cosal width and keratinized gingival height around maxillary implants in the esthetic zone without the color discrepancy associated with soft-tissue grafts. Figs. 1-2_ Patient with gingival recession and discoloration due Fig. 1 Fig. 2 to exposure of the underlying dental implants (teeth No. 7, 8, 9) three years after implant placement. Note the lack of keratinized peri-implant mucosa. (Photos/Provided by Dr. Bach Le) 04 I implants 1_2018