Soft Tissue Management

Introduction The soft tissue in the oral cavity may be linked to an outer frame that magnifies and complements the beauty of the natural teeth within. Without this outer frame the color, contrast, and luster of the teeth will not attain maximum attractiveness.

Clinicians seek to replicate in oral implantology to give natural tooth appearance

Unlike the natural dentition, a dental implant is a metallic body inserted into the jawbone. Therefore its collar does not receive any blood supply from a surrounding PDL or any other vessels

Peri-implant Vs. Periodontal Structure Gingiva & Alveolar Mucosa Bone Cementum PDL

Comparison of Vascular Topography Periodontium Periodontium Supracrestal vessels Vessels from PDL Vessels from PDLPeri-implant Terminal branches of larger vessels from periosteum Both built a crevicular plexus lateral to the JE.

Aesthetic implant positioning has a direct influence on the soft tissue profile and final appearance. The more precisely the implant positioned, the easier it will be to obtain a natural looking implant supporting restoration in its soft tissue housing

Accurate diagnosis and treatment planning set the stage for the timing for all events to follow It is important to be able to identify and classify the existing clinical conditions whether they are related to hard or soft tissue origin

Timing in relation to soft tissue management There are no specific time when management of peri-implant soft tissue should take place. Small and Tarnow classified management of the soft tissue around dental implants in the aesthetic zone into 4 categories :(1) before implant placement, (2) during implant placement, (3) at the time of abutment connection, and (4) at post-abutment connection

STM before implant placement To enhance the quantity or the quality of the soft tissue or to eliminate any existing soft tissue pathology at the site of imlant –Optimizing keratinized tissues –Socket seal

STM during implant placement One stage vs. two stage Immediate vs. delayed implant placement Guided tissue regeneration

STM at the time of abutment connection One stage vs. two stage

STM post-abutment connection manipulating the soft tissue after the prosthetic components are connected to the implant fixture can be called peri- implant tissue refining and profiling