Surgical Planning and Procedures
Consensus Statement
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A team approach and Esthetic Risk Assessment(1) should be utilized to improve predictability of an esthetic outcome and to reduce risk when managing soft tissue defects in the esthetic zone.
When soft tissue recession is found around a single-tooth implant, the clinician needs to diagnose the etiology based on evaluation of 3D implant position, restoration, existing hard and soft tissue support, as well as factitious (self-inflicted) injury such as tooth brushing and flossing trauma.
The surgical procedures to correct soft tissue facial recession around a single implant are complex. A systematic assessment and treatment protocol are required. The assessment should include the following:
When the above-mentioned factors are favorable, hard and/or soft tissue augmentation procedures can be effective. The patient should be made aware of the high variability of the outcome. When the abovementioned factors are unfavorable, hard and/or soft tissue augmentation procedures are less effective. Restorative modifications (abutment/crown replacement and/or reshaping) combined with a surgical approach may be indicated. Implant removal should also be considered as an option. When an implant needs to be removed, techniques that minimize bone loss are preferred. Specialized implant removal kits are available and preferred to trephines.
References:
(1) Martin WC, Morton D, Buser D. Diagnostic factors for esthetic risk assessment. In: Buser D, Belser U, Wismeijer D (eds). ITI Treatment Guide Vol 1: Implant Therapy In The Esthetic Zone - Single-Tooth Replacements. Berlin: Quintessence, 2007:11–20.
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