In a captivating EAO Prime Time Debate session, experts gathered to discuss the intricacies of repairing soft tissue defects and managing complications when things go wrong. Chaired by implant dental surgeon and periodontics specialist Isabella Rocchetta, the session brought together renowned professionals to share their experiences, solutions, and insights into soft tissue management. Here's a comprehensive summary of the key points discussed.
The Importance of Addressing Complications Isabella Rocchetta opened the session by emphasizing the often-overlooked topic of failures and complications in clinical practice. Unlike the perfect cases typically showcased at conferences, real-world clinical work inevitably involves encountering and managing complications. This debate aimed to shed light on these less-discussed issues, particularly focusing on immediate and long-term soft tissue complications.
Immediate Soft Tissue Complications The discussion began with immediate soft tissue complications, which occur within 14-21 days post-surgery. Gerhard Egerhot from the University of Freiburg shared a case involving extensive implant surgery. He illustrated the occurrence of a soft tissue dehiscence due to patient negligence, resulting in an exposed membrane and infection. His solution involved removing the affected area, thorough cleaning with chlorhexidine solution, and using topical antibiotics to promote secondary healing. The patient returned regularly for follow-ups, and within weeks, the tissue healed, allowing for successful implant placement and long-term stability.
Andy Timmerman from the University of Leuven presented a different approach using leukocyte-platelet rich fibrin (LPRF). This technique enhances soft tissue healing by providing growth factors, improving wound stabilization, and exhibiting antimicrobial properties. Timmerman highlighted how LPRF could be applied below mucoperiosteal flaps to promote healing, even in cases with compromised tissue. His case studies demonstrated successful outcomes with this method, reinforcing its potential benefits in managing soft tissue dehiscences.
Long-Term Soft Tissue Impairments The debate then shifted to long-term soft tissue impairments, focusing on issues such as implant-associated recessions. Arthur Nowzari from the University of São Paulo stressed the importance of prevention through meticulous treatment planning. He advocated for thorough assessment of gingival and bone phenotypes and the use of subepithelial connective tissue grafts during implant placement. Nowzari emphasized that prevention is far more effective than attempting to rectify complications after they occur.
Ignacio Sans Martín from Lausanne, Switzerland, discussed the necessity of autogenous connective tissue grafts for treating established soft tissue recessions. He emphasized that the root cause often lies in the improper positioning of implants, leading to buccal bone resorption and soft tissue thinning. Martín advocated for a combined surgical and prosthetic approach, adjusting abutments to leave space for soft tissue and using thick grafts with a high content of lamina propria for effective coverage.
The Debate on Autogenous vs. Alternative Grafts A significant part of the discussion revolved around the use of autogenous grafts versus alternatives like acellular dermal matrices and LPRF. While some panelists, including Nowzari, highlighted the necessity of autogenous grafts for their genetic compatibility and effectiveness in creating keratinized tissue, others like Egerhot and Timmerman pointed to the potential of alternative materials. The consensus was that while autogenous grafts remain the gold standard, ongoing research and development could lead to viable alternatives in the future.
Key Takeaways Prevention is Crucial: Proper treatment planning and assessment of gingival and bone phenotypes can prevent many complications. Immediate Management: For immediate soft tissue dehiscences, thorough cleaning, and use of topical antibiotics or LPRF can promote healing. Long-Term Solutions: Addressing implant positioning and using appropriate grafting techniques are essential for managing long-term soft tissue impairments. Autogenous Grafts vs. Alternatives: While autogenous grafts currently offer the best results, research into alternatives like LPRF and acellular dermal matrices is promising. The EAO Prime Time Debate provided valuable insights into managing soft tissue defects, highlighting the importance of prevention, meticulous planning, and the potential of emerging techniques and materials. As the field evolves, these discussions will continue to shape the future of soft tissue management in implant dentistry.