In the world of dental implants, one emerging issue that has garnered attention is the recession of soft tissues around implants. This problem not only affects the aesthetics of a patient's smile but also has significant biological implications. In a recent session of "Let's Talk," experts Sofia Aroca and Alfonso Gil discussed this growing concern, delving into its causes, prevention, and treatment.
Understanding Recessions Around Implants Recession around implants refers to the apical migration of the soft tissue margin, exposing the implant surface. This condition is akin to recession around natural teeth, where the gum tissue pulls back, revealing more of the tooth or implant. According to Sofia Aroca, a clinician and researcher from Paris, it’s essential to understand this basic definition as it sets the stage for discussing prevention and treatment strategies.
Why Are Recessions Problematic? Alfonso Gil, who is currently pursuing a postdoctoral program in prosthodontics at the University of Zurich, highlighted two primary issues caused by recession: aesthetics and biology. Aesthetically, even a millimeter of recession can be unacceptable to patients, making it a significant concern for those seeking dental implants. Biologically, recession can complicate oral hygiene practices, making it harder for patients to clean around the implant, potentially leading to discomfort and further complications.
The Statistics and Risk Factors While there is limited data on the exact prevalence of recession around implants, Gil noted that studies show about 10% of immediate implants experience more than one millimeter of recession, which is considered a failure. For conventionally placed implants, this figure can rise to 60% over two years, according to a study by Oates in 2002. However, Aroca emphasized that rather than focusing solely on statistics, clinicians should prioritize understanding the risk factors and etiology behind these recessions.
Key Risk Factors Identifying and mitigating risk factors is crucial in preventing recession around implants. Aroca pointed out several key factors, including thin mucosal phenotypes, lack of adequate keratinized tissue, improper implant positioning, and the patient’s oral hygiene practices. By evaluating these factors thoroughly before implant placement, clinicians can significantly reduce the likelihood of recession.
Prevention Strategies Both experts agreed that prevention is paramount. Gil outlined a three-pillar approach to preventing recession:
Soft Tissue Management: Ensuring adequate thickness and quality of the soft tissue around the implant. Hard Tissue Management: Grafting bone when there is less than two millimeters of buccal bone to ensure stability. Prosthetic Considerations: Proper implant positioning to allow for sufficient tissue thickness on the buccal side. Aroca added that a thorough clinical evaluation and risk assessment are essential steps in the prevention process. She stressed the importance of understanding and anticipating potential issues based on the individual patient's anatomy and oral health status.
Treatment Techniques When recession does occur, several surgical techniques can be employed to address it. Gil discussed the VISTA (Vertical Incision Subperiosteal Tunnel Access) technique, which allows for a remote surgical approach, minimizing trauma and preserving blood supply to the affected area. This technique involves using a vertical incision to access and treat the recession, ensuring stability and promoting healing.
Aroca, on the other hand, favors the tunnel technique, which maintains the vascularization of the flap and ensures blood supply to the grafted tissue. She emphasized the importance of preserving the marginal part of the flap to enhance the success of the procedure.
Conclusion Preventing and managing recessions around implants is a complex but essential aspect of implant dentistry. By understanding the risk factors and employing effective prevention and treatment strategies, clinicians can significantly improve patient outcomes. Both Aroca and Gil advocate for a proactive approach, emphasizing the importance of thorough evaluation and the use of proven techniques to address this growing concern.
As we look to the future, investing in research and clinical practices that prioritize prevention will be key to reducing the incidence of recessions around implants, ensuring better aesthetic and functional outcomes for patients.