Soft tissue managment

Knowledge of the wound healing process, the anatomy of vascular supply to the mucosa and gingiva, as well as incision techniques for flap formation is essential for surgical procedures in oral implantology. The goals of surgical soft tissue techniques include avoiding scar formation, creating adequate soft tissue volume, and preserving the interdental papillae. Magnification aids and microsurgical instruments can help keep procedures as atraumatic as possible. Adhering to the principles of incision for flap formation makes precise wound adaptation, rapid revascularization, and optimal blood supply possible. The biologic width, the dentogingival complex, and the gingival morphotype determine the principles of incision. Mucosal and mucoperiosteal flaps, as well as a combination thereof, keep obstruction of the soft tissue blood supply to a minimum and permit full coverage of the surgical field.

Free and pedicle grafts, preferably from the soft palate, afford diverse possibilities for soft tissue augmentation and improvement of gingival aesthetics. Sufficiently thick soft tissue protects peri-implant bone. Use of soft tissue grafts for sealing alveolar bone and provides a minimally invasive approaches for immediate implant placement. Soft tissue pedicle grafts are used for primary coverage and extensive alveolar ridge augmentation. Nowadays, the materials of choice for healing caps, gingiva formers, and abutments include titanium and/or zirconium oxide. Individual shaping and surface structuring procedures favor soft tissue attachment. Exposure techniques allow thickening and conditioning of peri-implant mucosa, as well as widening of the keratinized mucosa. Pedicle and/or free grafts enable reconstruction of papillae between implants. In this tutorial, the reader is educated on the current status of soft tissue grafting, prosthetic abutments, and exposure techniques.