A new concept for optimizing soft tissue integration.

6 INTERNATIONAL DENTISTRY SA VOL. 8, NO. 4 I n implant dentistry, soft tissue integration is the essential criterion of restorative success since osseointegration has become a routine and predictable phenomenon. In the anterior zone, the architecture, position, contour, and stability of the peri-implant mucosa – along with interproximalpapillae – determine the aesthetic outcome of implant procedures. Yet in the literature, marginal bone remodeling of 1mm to 1.5mm and soft tissue recession are often considered unavoidable. Therefore, clinicians acknowledge that implant placement in the anterior area can be risky, especially in thin periotypes, because some gingival recession frequently occurs after abutment connection. This is why the grafting of biomaterials, autogenous bone, and/or connective tissue is performed prior to or during implant placement in order to thicken the periimplant mucosa and to provide some measure of stability to the soft tissues. This helps prevent recession even though some bone loss occurs. Is there a less invasive and nonsurgical procedure that allows one to avoid gingival recession? As demonstrated herein, the behavior of the soft tissues can be dramatically improved through the use of transmucosal components with an altered design (Figures 1 through 3). While conventional abutments with divergent walls will compress and repel the peri-implant soft tissues, making them thinner and stretching the collagen bundles, the authors propose a paradigm shift. The transmucosal components’ design should be concave, inwardly narrowed in order to positively impact the soft tissues. Of course, they should be composed of a biocompatible material (eg, titanium, alumina, or probably zirconia) that allows adhesion of epithelium and connective tissue cells and avoids gold alloys and glazed laboratory ceramic. Gingival recession occurs with implants that have displayed some bone loss because their mucosal barrier is quite different from the seal around teeth. On natural teeth, the gingival ligament has a major role in attaching the gingivae to the roots through collagen bundles deeply inserted into the cementum (ie, Sharpey’s fibers). The network of collagen bundles is also more cross-linked and is more firm with four types of bundles (eg, transeptal, circular, dentoperiosteal, dentogingival). Figure 1: Root fracture of tooth #8 (11) following trauma. The teeth are splinted as an emergency treatment.