Soft Tissue Graft of a Restored Implant
I treated this case about 5 years ago. This 50 year old female suffered a motor vehicle accident approximately 10 years prior, and lost #7 that was subsequently restored with an implant. I am not sure who placed or restored the implant. The implant was stable but exhibited Miller Class I marginal tissue recession on the facial. As opposed to attempting hard tissue regeneration, as the implant fixture clearly lacked bone on the facial, a simple connective tissue “pouch” procedure was performed. It is my opinion that soft tissue quality and quantity is extremely important, yet often overlooked around implants.
12 Comments on Soft Tissue Graft of a Restored Implant
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Sean Rayment
1/10/2019
That is a nice case Tim. Not only esthetically improved but should help to preserve that facial bone with added attached tissue. I would love to see how it progresses over the next few years. Did you harvest CT for the graft or did you use some other material?
Timothy C Carter
1/10/2019
This is autogenous CT but I have done it with Puros Dermis as well. This one was a simple Pouch but I will sometimes do it via tunnel. I guess it just depends on my mood and the the situation. I believe that the autogenous CT is a great technique and in my hands the gold standard.
Richard Hughes DDS
1/10/2019
Nice result
R Gangji DDS, AFAAID
1/10/2019
Bravo Dr Tim ! Nice case , great service to patient ...showing the importance of soft tissue equal to the bone in my view... As the great clinician David Garber stated , “ Bone sets the tone, but Tissue is the issue”.
I see this with all my older cases where I neglected the soft tissue and. where crestal bone loss and some thread exposure occured. The thickness of tissue is that insurance policy that protects your bone from future dehiscence !! And implant exposure/long term failure.
I think courses on soft tissue management is a must for anybody placing implants
I would also recommend courses by Maurice Salaama and a gem of online lectures by the great professor Giovanni Zuchelli ( on his presentations at Osteocom website) where his superb videos lectures review cases in a step by step manner to understand the evidence and protocols of micro /periodontal surgery. They charge few hundred bucks ...so worth it to make you a better soft tissue dentist.
I hid all the 3,4, and 5 mm tissue punches from the other doctors at the office !
R Gangji DDS, AFAAID
1/10/2019
Just wandering if you have tried the tunneling vista techniques as well w/ CT grafts for general root coverage and implant exposed surfaces
Dr. Moe
1/10/2019
Dr. Carter,
Kick ass results!! Thanks for sharing this case. I have a lot to learn in tissue management and augmentation, so thanks for showing these cases.
Timothy C Carter
1/10/2019
On another note when autogenous soft tissue is used there is "creeping attachment" that occurs in addition to the initial coverage/augmentation that we do not usually get with Dermis/AlloDerm. I still use a lot of Dermis but something I always consider.
Timothy C Carter
1/10/2019
And I always use Chromic Gut suture for these procedures. Removing sutures is just an unnecessary evil in my opinion. Approximating wound edges for 4-7 days is plenty when proper surgical technique is done.
Dok
1/10/2019
Tissue follows bone eventually.....or doesn't it ?
R Gangji DDS, AFAAID, FIC
1/10/2019
But if tissue is thick it stabilizes bone resorption and bone loss is less , abundant blood supply to bone from soft tissue , ....And in all my years placing implants , I didn’t even know this until I heard Howie Glukman ( periodontist) at a Dental XP lecture. He stated , If thickness of tissue above platform of your fixture is good to 2- 3 mm or more Then you will get diminished or no crestal bone loss. However if tissue is very thin when you are covering your implant You will get some crestal bone loss , so In cases where I see the mucosa is really thin I will bury my implants 1 mm to 1.5 m. whenever I can.
Dorian Hatchuel
1/11/2019
Nice comments so far.
I'm just commenting in order to get notified about further comments.
DrK
1/14/2019
Kudos, great results!
