Implant Plastic Surgery: A Review and Rationale
Implant dentistry has been established as a predictable treatment modality with high clinical success rates. Esthetic considerations of implant restorations have been gaining increased interest over the years. The role of periodontal plastic surgical procedures in the creation and maintenance of peri-implant soft tissue heights to facilitate better esthetics has become more popular. The available plastic surgery procedures and their clinical applications are reviewed in this article. Emphasis is placed on factors to consider for proper case selection and ideal treatment planning.Abstract
Ridge (socket) preservation. (a) Root tip was left on tooth #8. (b) Periotome (Hu-Friedy, Chicago, Ill) was used to loosen (via periodontal ligament space) the remaining root in the socket. (c) The tooth was atraumatically extracted, preserving the labial bony plate. (d) Socket occlusal view showed signs of angiogenesis. (e) Demineralized freeze-dried human bone allograft (Puros, Centerpulse, Carlsbad, Calif) was placed on the bottom two thirds of the socket. (f) Colla-plug (Centerpulse, Carlsbad, Calif) was cut and placed on the top one third of the socket. (g) Socket was compressed with all the materials underneath. (h) Cross mattress suture with 4-0 Vicryl suture (Ethicon, Inc, Somerville, NJ). (i) Two weeks postoperative showed uneventful healing
Bone augmentation to enhance soft tissue profile. (a) Tooth #9 has root fracture. (b) Occlusal view of the healing socket. (c) Initial incision. Two vertical, diverging, releasing incisions were done. (d) Full thickness periosteal reflection indicated inadequate bone width for proper implant placement. (e) Implant drill sequence (2 mm twist drill). (f) Implant (3.75 × 13 mm) placement (Nobel BioCare, Yorba Linda, Calif). (g) Decortication was performed using one-half round bur on the side of the implant to promote regional acceleratory phenomenon (RAP). (h) Demineralized freeze-dried bone allograft was placed. (i) Collagen membrane (BioMend Regular, Centerpulse, Carlsbad, Calif) was placed to cover the bone graft area and extended to the lingual. (j) Sutured with passive tension. A modified vertical mattress suture was placed on the center of defect to ensure proper wound coverage. (k) Two weeks postoperatively showed uneventful healing. (l) Four months healing after ovate pontic site development by temporary crown. (m) New bone formation was noted on the buccal side. (n) Healing abutment was placed. (o) Sutured around healing to allow soft tissue maturation. (p) Two weeks after healing. (q) Final radiography. (r) Final restoration
Immediate implant placement. (a) Tooth #10 has fractured apical to the CEJ. The crown was bonded to the adjacent teeth by the referring dentist. (b) Occlusal view of the remaining root in the socket. (c) The tooth was atraumatically extracted, preserving the labial bony plate. (d) Endosseous implant placed (occlusal view). (e) Endosseous implant placed (facial view). (f) Indexing of the implant was performed. (g) The crown was rebonded as a temporary restoration. (h) The replicated cast used for crown fabrication. (i) Final view after 6 months. Note the preservation of the interproximal papilla
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Contributor Notes
Christopher E. Kazor, DDS, MS, PhD, is in private practice in Lansing, MI
Khalaf Al-Shammari, DDS, MS, is a staff dentist in the Ministry of Health, Kuwait
David P. Sarment, DDS, MS, is an assistant professor in the Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI
Carl E. Misch, DDS, MDS,is an adjunct professor in the Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, and is in private practice
Hom-Lay Wang, DDS, MSD, is a professor and director of Graduate Periodontics, Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI. Address correspondence to Dr Wang at the University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109-1078 (homlay@umich.edu)