A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant

The aim of the study was to evaluate soft-tissue coverage and patient aesthetic satisfaction of a novel surgical-prosthetic approach to soft tissue dehiscence (STD) around single endosseous implant. MATERIAL AND METHODS: Twenty patients with buccal soft tissues dehiscence around single implants in the aesthetic area were consecutively enrolled. Treatment consisted in: removal of the implant supported crown, reduction in the implant abutment, coronally advanced flap in combination with connective tissue graft (CTG) and final restoration. The unrestored contralateral tooth normally positioned without recession defect was used as a reference. The soft tissue coverage and patient satisfaction were evaluated 1 year after the final restoration. RESULTS: One-year mean STD coverage was 96.3%, and complete coverage was achieved in 75% of the treated sites. The increase (1.54 \ub1 0.21 mm) in buccal soft tissue thickness (STT) at 1 year was significantly correlated with CTG thickness at time of the surgery. The mean difference between graft thickness and STT increase was 0.09 \ub1 0.14 mm, corresponding to the 5.8% of the original graft thickness. The aesthetic analysis showed a significant improvement between the baseline (median, 3.8; 95% CI, 2-4) and the 1-year (median, 8.0; 95% CI, 8-10) visual analogue scale (VAS) scores. CONCLUSION: The results from the present study demonstrated that the proposed bilaminar technique was effective in the coverage of buccal STD around single dental implant and the suggested prosthetic-surgical approach was aesthetically successful

Predetermination of root coverage

BACKGROUND: A method to predetermine the maximum root coverage level (MRC) achievable with surgery was recently presented. The present study evaluates the predictability of such a method by comparing the predetermined MRC with that effectively achieved by means of root coverage surgical procedures. METHODS:A total of 50 patients with single and multiple recession defects were enrolled. MRC was predetermined by an independent periodontist by assessing the ideal height of the interdental papilla. The distance from the apical reference point of a stent (StRP) and the MRC was measured 7 days before root coverage surgery. A total of 135 Miller Class I, II, and III gingival recessions were treated with the coronally advanced flap (CAF) or with the subepithelial connective tissue graft (SCTG). The distance from StRP and the gingival margin (GM) was measured by another independent periodontist 15, 30, and 90 days after surgery. RESULTS:In 97 (71.8%) of 135 treated gingival recessions, the StRP-MRC distance coincided exactly with the StRP-GM distance. No statistically significant difference was demonstrated in the cases with exact predetermination between gingival recessions belonging to the maxilla or mandible and between gingival defects treated with CAF or SCTG. The StRP-MRC distance measured before surgery was greater in 24 recession defects (17.7%) and lower in 14 gingival recessions (10.3%) than the StRP-GM distance measured 90 days after surgery. More cases of underestimation and fewer cases with overestimation of the level of root coverage were found in the SCTG group compared to the CAF group. The difference was statistically significant (P <0.01). CONCLUSIONS:The adopted method was effective in predetermining the position of the soft tissue margin 90 days after root coverage surgery. The cases with underestimation of the level of root coverage should be considered clinically and esthetically successful