Management of the Ailing Implant: An innovative technique for the treatment of labial gingival recession around dental implants
Statement of the problem:
Gingival recession around dental implants in the esthetic zone can be problematic. The purpose of the present study was to describe the outcome of an innovative surgical technique for the treatment of labial gingival recession around a dental implant in the esthetic zone.
Materials and Methods:
Records of 14 patients (7 male, 7 female) with an age range of 20-64 years [mean (SD) =36.78 (13.9) years] were used for this retrospective study. The inclusion criteria were patients who had localized gingival recession/dehiscence defect around the labial aspect a dental implant located in the esthetic zone. Patients with implants in poor apical-coronal and/or labial-palatal positions were excluded. Patients were treated with aesthetic contour bone augmentation (1) using guided bone regeneration (GBR, collagen membrane) with a mineralized allograft in combination with a roughened titanium tenting screw placed 3-4 mm below the implant platform, and coronal advancement flap. The hard and soft tissues around the implant were evaluated at 6 months and approximately 1 year after treatment. Pre- and post-operative clinical, cone beam computed tomography (CBCT), and restorative cast measurements were made for all patients.
Methods of data analysis:
Descriptive analysis, such as mean and standard deviation (SD)
Results:
The mean (SD) of pre-operative crestal (2 mm from crest) and mid-implant buccal bone thickness increased from 0.18 (0.45) mm and 0.64 (0.68) mm to 2.02 (0.88) mm and 2.71 (0.34) mm, respectively, approximately one year after treatment. The mean pre-operative soft tissue thickness [measured at implant platform level on study casts or by using CT scan if casts were not available (2)] increased from 1.53 (0.43) mm to 2.81 (0.45) mm. Further, the average width of the labial keratinized tissue improved, from 2.53 (1.26) mm to 3.82 (1.05) mm, and the mean gingival margin height (measured on soft tissue casts with a digital caliper) increased from 1.64 (0.50) mm to 2.87 (0.28) mm. The mean pre-operative tooth length reduced from 10.89 (1.26) mm to 9.64 (0.84) mm (measured using casts).
Conclusions:
The use of a mineralized allograft with roughened tenting screws and collagen membrane coverage was effective in improving peri-implant soft tissue around ailing implants with gingival recession.
References:
1-Le BT, Borzabadi-Farahani A. Simultaneous implant placement and bone grafting with particulate mineralized allograft in sites with buccal wall defects, a three-year follow-up and review of literature. J Craniomaxillofac Surg. 2013, doi: 10.1016/j.jcms.2013.07.026.
2-Januário AL, Barriviera M, Duarte WR. Soft tissue cone-beam computed tomography: a novel method for the measurement of gingival tissue and the dimensions of the dentogingival unit. J Esthet Restor Dent. 2008;20:366-73.