In a series of 20 patients, a submarginal connective tissue graft led to improved horizontal and vertical soft tissue increases around single implants with shallow buccal bone dehiscence.
The success of dental implantation relies on the condition of the underlying alveolar ridge. Defects may result in implant exposure and poor long-term outcomes. Previous research has indicated an association between greater soft tissue thickness and less crestal bone loss and avoidance of marginal bone recession, leading the authors of the current article to hypothesize that proactively increasing soft tissue thickness may reduce the risk of mucosal recession and crestal bone loss.
«The aim of the present case series study was to evaluate short- and long-term (3 years) soft tissue stability after a surgical technique combining transmucosal implant placement with submarginal connective tissue graft in an area of shallow buccal bone dehiscence.»
Stefanini et al. in the cited publication
The authors therefore recruited 20 individuals requiring implant surgery. During surgical site preparation, a connective tissue graft harvested from the palate was sutured at the inner surface of the buccal flap, 1 mm apical to the flap keratinized tissue margin. All patients then received a transmucosal implant 10 mm in length and either 3.3 or 4.1 mm in diameter (for premolar and molar replacement, respectively). Healing was uneventful for all cases, and no implant sites showed signs of peri-implantitis or mucositis.
A significant clinical vertical soft tissue augmentation was observed between measurements pre-surgery and at 6 months, 1 year, and 3 years post-surgery, as well as between measurements taken at 1 and 3 years post-surgery (all P<0.01). Keratinized tissue height increased significantly between surgery and the 3-year follow-up (P<0.05). Soft tissue thickness was also significantly increased between surgery and at 6 months, 1 year, and 3 years of follow-up (P<0.01). This allowed the soft tissue margin of the final prosthetic crown to be placed more coronally to the baseline soft tissue level. There was no significant differences in marginal bone loss between the time of surgery and the 6-month, 1-year, and 3-year follow-ups.
Dr. med. dent. Thomas Meier
This paper describes the importance of soft tissue thickness for successful dental implantation.
To conclude, the authors report for the first time a simultaneous vertical and horizontal soft tissue augmentation. They propose that the connective tissue graft prevented shrinkage of the coronally advanced flap, possibly through the submarginal positioning of the graft and the coronal advancement of the flap. While noting the limitations of a single case series, these findings indicate the importance of the soft tissue in successful dental implantation.
