Soft Tissue

Implant connections
Soft Tissue Management

The connection between implant and abutment is present on the entire implant line, depending on the diameter of the flaring required, respectively 3.5 mm or 5 mm. An emergence profile is also available, which ensures a more rounded connection without sharp corners, creating a greater space for mucosa anchoring. This profile which guarantees conditioning of the soft tissues is contemplated on the whole prosthetic range, from healing screws right up to the final abutments.

The importance of the correct management of soft tissue is essential to obtain predictability in implantology and periodontology surgery, especially when regenerative techniques are applied. To obtain clinical success, we should consider two factors: the choice and the correct execution of the most indicated flap for the specific type of intervention that is planned, and the most adequate suturing technique. Furthermore, the importance of the keratinized gingiva around dental implants has been demonstrated to obtain long-term stability, with reduced in the risk of peri-implantitis, often obtainable simply by handling properly soft tissue during implant placement, or in the second surgical phase.

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Treatment flow

1. Case analysis and treatment planning : Soft tissue management begins during the case analysis because the shape of the soft tissue must be analyzed and their preparatory treatment is influenced by the positioning of the implant. Each case is different, therefore an initial phase of accurate analysis and planning is useful to achieve the desired aesthetic result. Different factors (eg indication, patient expectations, the shape of soft tissue, bone quality, site location) affect treatment outcome. The level of difficulty and the inherent risk of individual procedures can be evaluated. In general, the level of difficulty increases in a way that is directly proportional to the number of phases involved and to the aesthetic result that must be obtained for a satisfactory result. An increased level of complexity in aesthetic generally includes longer treatment times and higher costs. The information and the preparation of the patient at the beginning of the treatment can encourage and facilitate his collaboration.
2. Surgical treatment and healing phase: According to the case and his preferences, the doctor will choose a submerged or transmucosal approach. With the submerged approach, a prosthetic screw is placed after implant insertion and then flap should be closed. After a first healing phase there’s a second operation, the healing abutment is placed and preparatory soft tissue treatment is started. The first soft tissue profiling phase begins with the secondary healing component. Bone Level healing abutments were developed to relate to the size of the secondary components for the final restoration. The transmucosal approach allows a direct procedure, avoiding a second operation. The decision on which secondary component to use for the final restoration must be taken at the beginning of the treatment, to choose the healing abutment. Therefore, sophisticated planning and excellent communication between the doctor in charge and dental laboratory are required. These two alternatives aims to satisfy additional needs for individual cases and should be based on user preferences.
3. Timing (soft tissue modeling): After the first healing phase, soft tissue can be modelled with the help of temporary abutments. The additional preparatory soft tissue treatment with the temporary abutment may allow to obtain a better aesthetic result and to expand the soft tissue when necessary. The papillae can be further shaped and adapted to the final restoration. In these phases, the patient must be informed of the extra necessary effort to increase the aesthetic result. Again, excellent communication between the doctor in charge and dental laboratory supports the final result.
4. End of treatment and follow-up: Once the prosthesis has been positioned and adapted and the treatment is finished, regular checkups and good oral hygiene help prevent any side effects and keep patient satisfaction high.