BIOBRIEF
Avoiding Post-Implant Placement and Long Term Crestal Bone Resorption by Thickening Vertical Soft Tissue
THE SITUATION
Our patient is a 60-year-old caucasian male that had just finished a large ridge augmentation in the area of #4 and #5. We used the sausage technique for the ridge augmentation and yielded excellent bone volume in this area. However, as we began the 2nd stage implant placement procedure, we noticed, as is frequently seen following a large ridge augmentation, very thin vertical soft tissue over the crest of the bone. We know that inadequate soft tissue thickness will lead to compromised vasculature and transfer of oxygen and nutrients to the bone which can absolutely lead to a loss of crestal bone surrounding the implants.
THE RISK PROFILE
| Low Risk | Medium Risk | High Risk | |
|---|---|---|---|
| Patient’s health | Intact immune system | Light smoker | Impaired immune system |
| Patient’s esthetic requirements | Low | Medium | High |
| Height of smile line | Low | Medium | High |
| Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
| Shape of dental crowns | Rectangular | Triangular | |
| Infection at implant sight | None | Chronic | Acute |
| Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
| Restorative status of adjacent tooth | Intact | Restored | |
| Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
| Soft-tissue anatomy | Intact | Compromised | |
| Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
Note: Bone was augmented prior to this case report due to a severe horizontal defect.
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download pdfTHE APPROACH
Our goal here is to create increased vertical soft tissue thickness over the crest of the implant site. Following implant placement and placement of the cover screws, we used Geistlich Fibro-Gide® over the implants and then layed it over the crest and buccal aspect. Following the placement of Geistlich Fibro-Gide®, we gently released the full thickness flap so that we can achieve tension-free primary closure over the site.
The use of Geistlich Fibro-Gide® is a wonderful alternative to using a connective tissue graft to thicken vertical soft tissue, which will help minimize crestal bone loss around implants.
THE OUTCOME
The soft tissue that will now surround the implant site is thick and healthy due to the use of Geistlich Fibro-Gide® at the time of implant placement. This is a simple technique and only requires a minimal amount of flap release to achieve tension-free primary closure over the site. The results are phenomenal and will be beneficial for the stability of the crestal bone surrounding the implants for years to come.
Tamir Wardany, D.D.S.
Dr. Wardany is a graduate of Meharry Medical College School of Dentistry in Nashville, TN. After completion of a dental implant fellowship through State University of New York Stonybrook, he continues to spend extensive time in Europe training under Dr. Istvan Urban in the field of advanced bone and soft tissue regeneration.
He is a Diplomate of the American Board of Implantology, and lectures extensively on the topic of bone regeneration. He maintains a referral based surgical implant practice in San Francisco and Sacramento, California.