Comprehensive management of peri-implant soft tissue defect. A case report

Background. Dental implants have become the most accepted treatment option for patients needing tooth replacement because they deliver the best functional and aesthetic results with proper planning and case selection. Apart from achieving osseointegration, healthy and maintainable peri-implant soft tissue is of paramount importance. This case report focuses on the comprehensive management of peri-implant soft tissue recession in relation to implant #22.

Case report. Clinical examination showed more labially placed implants with the prosthesis in relation to #22, with labial gingival recession extending up to the vestibule, exposing three implant threads, with a clinical attachment loss of 7 mm. A combination of non-surgical periodontal therapy (Mechanical debridement using a plastic curette and laser debridement with a 2780 nm Er, Cr: YSGG laser, Waterlase, USA) and surgical therapy (implantoplasty, implant surface decontamination with antimicrobial photodynamic therapy (a-PDT) using a 660 nm diode laser, and lateral pedicle flap with sub-pedicle connective tissue graft) was performed. The patient was recalled, and the surgical site was re-evaluated after 1 week, 1, 3, and 6 months.

Results. The follow-up examination at 1 week revealed mild inflammation and satisfactory healing, with complete coverage of the exposed implant surface. The follow-up examination at 1 week revealed mild inflammation and satisfactory healing, with complete coverage of the exposed implant surface.  At the 6th month follow-up, complete coverage was still maintained with more keratinization of the augmented soft tissue.

Conclusion. Comprehensive management of peri-implant soft tissue defects is the key to complete soft tissue coverage in the long term, which relies on adequate preoperative assessment, selection of a suitable surgical technique, execution of an implant disinfection protocol, and correction of improper prosthetic components.