Implant site development

Site development in the esthetic zone for ideal soft and hard tissue conditions

Stable and healthy soft tissue conditions are important for the longevity of implant restorations and crucial for their esthetic success especially in the anterior region. Tooth loss and subsequent bone changes may result in inadequate bone volume for placing implants. The buccal plate and the bundle bone are a tooth related structure, and will be lost after tooth loss, resulting in average almost 4 mm bone loss horizontally and 1.5 mm vertically. Placing an implant as single measure cannot avod this bone loss, as the implant will not have a Sharpey fibre system. Objectives for horizontal and vertical grafting comprise improved tissue contour and volume, optimizing the implant position in all planes and esthetic results, support the biological width and gingival stability. There are various techniques and protocols for soft and hard tissue regeneration and augmentation for implant site development, such as connective tissue grafts, bone block grafts or guided bone regenaration with membranes. Platfom shift implant and adequate concave abutment emergence profile design can further incresase the soft tissue volume.


Expert insights

Starting at 16:32. Review of parameters for soft tissue augmentation and stability. Dr Rompen presents a clinical procedure how to maintain the tissue volume, based on non-resorbable osseoconductive hydroxyapatite fillers and connective tissue graft procedures. Video reviews aspects of the biological width, gingival biotypes, implant and abutment design, material biocompatibility, prosthetic procedures.
Starting at 4:40, section till 5:58. Placement a connective tissue graft in the esthetic zone, discussion and literature review on connective tissue graft and filler material between implant and the buccal bone. Video reviews treatment options, treatment steps with implants and full ceramic Zirconia crown restorations, model based planning, provisionalization concepts, atraumatic removal of the fractured teeth and roots, final restoration try-in and cementation procedures.
Starting at 18:11, Insight in interaction of implant size, diameter, position and socket form, influences of crestal bone condition and biologic width. Section at 19.00 comparison of situations with and without grafting and gap management. Graft gap between implant and buccal plate, soft tissue graft on facial side of the site, discussion of volume overcompensation for buccal contour remodeling changes. Section after 34:00, clinical case, gap management and soft tisssue graft in tunneling technique.
Starting at 6:00, insight in connecitve tissue graft technique, soft tissue graft from tuberosity region.
Starting at 8:40, insight on esthetic reasons being the single largest reason for grafting with dental implants. 90 % of the missing teeth in the anterior maxilla require some type of tissue augmentation. At 18.00, grafting in single tooth defect situation, with a block ramus graft as on the most popular donor sites. Other grafting techniques presented are guided bone regeneration with membranes (GBR), allografts with mesh, iliac crest grafts, and bone regeneration using bmp bone morphogenetic proteins.
Supported by several patient treatment examples, the lecture gives insight in how to handle cases with reduced or diseased periodontium in the esthetic zone. Reviews biological principles for soft tissue management, flap techniques, soft and hard tissue grafting aspects and emergence profile design with provisionals.
Quintessential review of history, principles and potential future developments of guided tissue regeneration (GBR), in single and multiple implant cases in the esthetic region. Discusses physiological bone resorption patterns after tooth extraction, gingival biotypes, biological width. For horizontal augmentation resorbable membranes are mostly used, for vertical augmentation reinforced, non-resorbable membranes are the option of choice. 18.15. Review of Creos Xenoprotect.