Implant collar and implant body appearance coverage: a case report.
Tizzoni R., Tizzoni M. MD & DDS
30, Via San Barnaba 20122 Milan Italy
www.tizzonimediciodontoiatri.it
tizzoni.med@libero.it
491
Topic: Technical and biological complications
Abstract
Results
A surgical procedure for an implant collar and implant body appearance
coverage is presented.
Implant collar and implant body coverages were achieved and maintained
for all the 1-year follow-up period. After 1 year soft tissue shrinkage was
minimal.
Background and Aim
The presence of keratinized mucosa at implant sites was associated with
less morbidity and high survival rate (1). Moreover the importance of = or
> 2mm width of keratinized mucosa around implants on long-term periimplant soft tissue health and stability was stated (2). The mucosal
attachment (mobile vs. non-mobile) and the mucosa thickness are the two
other key factors to obtain this stability of the peri-implant mucosa at the
vestibular aspect (3). The soft tissue stability, in cooperation with
subjacent bone level, in a fixed implant-supported prosthetic
rehabilitation is the foundation to achieve an aesthetic result, especially in
the anterior superior area (4,5,6). If immediately after implant placement
there is a residual bone thickness < 1.8 mm a significant amount of bone
loss is expected to occur for the time between implant insertion and
abutment connection (7) and aesthetics can be jeopardized.
The aim of this case report was to evaluate the healing outcome, at one
implant site, of the coverage of soft tissue lack, with implant collar
exposure, and bone lack, with implant body appearance, with a coronally
advanced flap in combination with a free connective tissue graft.
Methods and Materials
A complex prosthodontic case of a 57 Year old woman with one mucosal
recession defect at an implant site was recruited. After diagnostic workup, tooth 2.3 was extracted for root fracture, an implant was inserted and
an immediate provisional fabricated. Afterwards fixed provisional
restorations rehabilitated the natural dentition and were evaluated
clinically, adjusted according to esthetic, phonetic and vertical dimension
criteria. Subsequently other implants were inserted and immediately
provisionalised in position 1.4,4.4,4.5. Implants in position
1.7,1.6,2.7,3.6,4.6 were inserted according to a two stage approach. One
year after loading the implant in position 2.3 with a provisional restoration,
due to soft and hard tissue lack, displayed implant collar exposure and
implant body appearance. For this reason it was surgically covered
performing a coronally advanced flap in combination with a free
connective tissue graft sutured to the intact neighbouring tissues. Healing
was studied at 1, 3 , 6 months up to 1 year post-operatively.
The prosthetic case was then completed with free standing metal-ceramic
crowns rehabilitating natural tooth 1.5, free standing alumina crowns from
tooth 1.3 to tooth 2.2, one pontic from 2.4 to 2.6 to restore tooth 2.5, , free
standing metal-ceramic crowns to restore implants 1.4,2.3,2.7,3.6 and
jointed crows for implants 1.7 and 1.6 and from 4.4 to 4.6.
Conclusions
The surgical coronal mucosal displacement in combination with the
connective tissue grafting were clinically beneficial for the implant site.
Notably aesthetics resulted highly enhanced.
References
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Presented at the 20th Annual Scientific Meeting of the European Association of Osseointegration
10-13 October 2012, Copenhagen, Denmark