Peri-implant tissue development
- Introduction
Teeth and dental implants are two examples of structures that pass through the integuments.
While anchoring an implant in bone is a prerequisite for its stability, its long-term retention appears to depend on its epithelial and connective tissue attachment to the titanium surface. Periodontal tissues (gingiva and alveolar bone) and peri-implant tissues have been shown to have many common clinical and histological factors.
- Soft tissue development
- Interest in peri-implant tissue planning
Indeed, the morphology and health of the peri-implant gingiva have become major tissue objectives, both to obtain better aesthetic integration and to facilitate hygiene and maintenance.
Prophylactic interest
Aesthetic interest.
- pre-implant tissue planning
Typically, this stage is more reserved for bone reconstruction of the site.
The main reason for avoiding any pre-implant development is the difficulty of locating the precise location of future implants and the difficulty of understanding the evolution of the peri-implant soft tissues; it is necessary to avoid carrying out muco-gingival developments before the placement of the implants (according to GARDELLA and MATTOUT 1993).
But this cannot in any way prevent the existence of some tissue arrangement techniques in the pre-implantation phase.
- Soft tissue thinning (mucoectomy)
- Removal of gingival growth by mucoectomy
- Elimination of bridles and brakes
- Laterally displaced flap
- Roller technique
- Apically displaced flap
- Epithelial-connective tissue graft
- Buried conjunctival graft
- Tissue development during implantation
It is possible to correct the lack of thickness at this time by a buried connective tissue graft. The technique used is the same as that used in mucogingival surgery around natural teeth.
There is also the technique of papillary regeneration of PALACCI P.: Displaced flap with proximal pedicles
- Tissue development after implant placement
After implant placement and supra-implant prosthetic reconstruction, a reassessment of the peri-implant gingiva must be made. Indeed, changes to this gingiva may have occurred since the prosthetic restoration was placed. A reassessment is therefore recommended in order to define the necessary adjustments around the implant, to find a peri-implant environment as close as possible to the ideal.
- Epithelial-connective tissue graft
- Reconstruction of the taste buds
- Elimination of gingival hypertrophies
- Arrangement of hard tissues
- Bone defects applied to implantology
The use of dental implants in partial or total rehabilitation is a treatment with good predictability, survival rates are greater than 90% at 10 years. However, despite the many advanced technologies in the field of implantology, the quantity/availability of bone is still the necessary prerequisite for the survival of the implant and its aesthetic integration. Alveolar defects are nevertheless often present, due to traumatic, pathological, infectious, physiological causes of an unreplaced tooth or following a complex avulsion.
- Bone grafts
In implant surgery, bone supply to the maxilla or mandible pursues two main objectives: the achievement of a satisfactory bone contour and volume;
The creation of a mechanical support to facilitate the placement of implants in conditions allowing their osteointegration.
- Arrangement of hard tissues before implantation
- Ridge Translation Osteotomy
The goal is to increase bone height by coronally moving the osteotomized crest.
It is associated with interposition material in the space thus created: autologous bone graft (cortical or cortico-spongy block) or biomaterial. It is indicated in the case of a wide crest to obtain a height gain limited to a few millimeters.
Peri-implant tissue development
- Guided bone regeneration
It is a biological process that allows the restoration of bone tissue ; It is necessary to have a source of osteogenic cells near the area to be regenerated. Bone has a natural capacity for healing/regeneration. The membrane acts as a barrier by isolating the osteoprogenitor cells and the bone matrix from contamination by connective (fibroblasts) and epithelial cells.
- Sinus lift
The surgical approach can be lateral or crestal. The filling material can be either autogenous bone of extraoral origin, autogenous bone of intraoral origin, or a biomaterial. The choice of surgical procedure is guided by the Jensen classification which is based on the height of residual alveolar bone in relation to the maxillary sinus.
- Alveolar distraction
Osteogenetic distraction is defined as the result of gradual traction on living tissue. This traction creates tension that can stimulate bone formation and maintain the regeneration of this newly formed bone. The method involves inducing the formation of new bone by applying constraints. The constraint is applied to the bone tissue through a worm screw that causes the progressive separation of two bone fragments from each other
- Development during implementation
- Ridge Expansion
The aim is to increase the thickness of the crest. The procedure consists of an osteotomy limited to the buccal cortex (corticotomies) allowing an expansion of the crest by cleavage after obtaining a greenstick fracture.
It is indicated in case of a high but insufficiently thick crest. The minimum thickness of the crest must be at least 3 mm to allow this technique. Here too, the bone sections must be as thin as possible.
- Guided bone regeneration concomitant with dental implant placement
- subsinus filling by trans-alveolar route
- treatment of dehiscences and implant fenestration
- post-implant development
- Access flap/osteoplasty
Its objective is to eliminate or, at least, reduce the peri-implant pocket and to restore the peri-implant soft tissues to a morphology compatible with satisfactory access to oral hygiene. The elevation of a mucoperiosteal flap will allow the cleaning, and possible treatment, of the implant surface, the elimination of granulation tissue and osteoplasty if necessary.
- Filling/regeneration techniques
In the presence of infra-bony peri-implant defects and craters, the use of filling and/or regeneration techniques derived from periodontal surgery may give hope for reconstruction, even if only partial, of the tissues destroyed by the peri-implant pathology.
Peri-implant tissue development
Baby teeth need to be taken care of to prevent future problems.
Periodontal disease can cause teeth to loosen.
Removable dentures restore chewing function.
In-office fluoride strengthens tooth enamel.
Yellowed teeth can be treated with professional whitening.
Dental abscesses often require antibiotic treatment.
An electric toothbrush cleans more effectively than a manual toothbrush.