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ePaper created 2018-03-14, 10:36:46 | version 1.38.0
C.E. article_ labial soft-tissue recession I C Fig. 10 Fig. 11 Fig. 12 Fig. 13 Figs. 10-11 _Screw tent-pole grafting technique was again employed to enhance the vertical dimension of the pontic site. The mineralized allograft was covered with a cross-link collagen membrane. Fig. 12_Healing at 12 months after implant removal. Note improvement in the vertical height of the ridge and soft tissue dimensions around the implants at the pontic site. Fig. 13_Screw-retained provisional restoration. Fig. 14_Delivery of definitive restoration. Fig. 15_Eight years follow-up. Fig. 14 Fig. 15 suggested that sites with minimal keratinized tissue might be prone to a lower incidence of periodontal pocket formation.20,23 In the anterior maxilla, as labial bone thickness resorbs, there is a corresponding loss in labial soft- tissue thickness around the implant.24 Moderate recession can make thin, pink gingival tissues appear dark because of the presence of the underlying metal abutment and implant, and further bone loss can cause unsightly metal exposure above the gingival margin. In general, implants carry a higher risk of soft- tissue complications when placed in thin tissue bio- types or with labial inclinations when the labial plate thickness is <2 mm.24-25 Use of an opaque abutment, such as zirconia, has been reported to produce the least amount of gingival color change when gingival thickness was <2 mm, whereas any abutment mate- rial resulted in satisfactory esthetics when gingival tissue thickness was >2 mm.24,26 The goal of the GBR procedures in the present case was to treat the facial bone defects as well as restore the esthetic gingival margin. The efficacy of allografts and GBR surgical protocols in repairing alveolar de- fects is documented in the dental literature.27-29 While some allogenic30-31 and xenogenic32 tissues have demonstrated efficacy in soft-tissue augmentation, the use of a collagen membranes with a mineralized allograft for soft-tissue augmentation is not well- documented. In the present case, use of a collagen membrane in combination with a mineralized bone allograft resulted in gain in keratinized tissue width and gingival height. While the goal of the GBR procedure was to treat the bone defect in the present case, improvements were coincidentally observed not only in the soft- tissue dehiscence, but also in the keratinized tissue width and soft-tissue thickness. The use of mineral- ized allograft placed around 1.5 mm titanium screws (“screw tentpole”) to tent out the soft-tissue matrix and periosteum has been previously reported for successful alveolar ridge reconstruction.33 Although there are no reports of a GBR procedure resulting in clinical increases in both of the latter soft-tissue dimensions, a limited number of retrospective stud- ies14,24,34 have reported an increase in soft-tissue thickness around dental implants primarily in the implants 1_2018 I 07