In this episode of EAO Just Ask, Professor Martina Stefanini, a leading periodontology expert, shares her insights on managing soft tissue around failed implants, particularly focusing on aesthetic outcomes. Hosted by Garrett Heikope, the live session provided an opportunity to answer pressing questions on the subject.
Martina explained that "failed implants" in this context refer to those with aesthetic issues, not necessarily exposed implant threads. These failures are identified by issues with the gingival margin, such as an improper alignment with the adjacent natural teeth. The goal is to reposition the soft tissue margin and increase tissue thickness to enhance both aesthetics and long-term health.
Martina emphasized the importance of understanding which defects can and cannot be treated. Key factors include the health of the implant, the absence of perimplantitis, and the positioning of the implant. She explained that cases with poor implant angulation, inadequate interproximal tissue, or excessive buccal displacement are difficult to address effectively.
A combined prosthetic and surgical approach is crucial for successful outcomes. One example involved removing the implant crown to create space for soft tissue to grow, thus enhancing vascular supply and tissue quality before proceeding with surgical correction. This pre-surgical phase allows the soft tissue to thicken, making it possible to perform more effective tissue advancement during surgery.
Martina also discussed her classification system for peri-implant aesthetic defects, which includes four classes based on implant and crown position, with subclasses indicating the quality of interproximal soft tissue. This system helps determine the most appropriate treatment approach, balancing both surgical and prosthetic considerations.
Ultimately, the session provided valuable guidance on managing soft tissue defects around implants and the importance of preventive measures during implant placement to avoid such issues in the first place.