Preservation of keratinized gingiva around dental implants using a diode laser when uncovering implants for second stage surgery

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

Employment of U-Shape Technique at Re-Entry Surgery for Papillae Coronal Migration on the Rehabilitation of Anterior Single Implant: 3-Year Follow-Up Case Report

INTRODUCTION

The rehabilitation of a maxillary single dental implant represents a great challenge at clinical practice. Harmony among the implant-supported crown and adjacent teeth is required in which concerns pink and white esthetics. The aim of the present case report is to depict a multidisciplinary treatment in which the U-shape flap technique for papillae preservation at second stage surgery was used.

CASE PRESENTATION

One female patient presenting an un-rehabilitated dental implant at the left central incisor position sought treatment at the Centre of Education and Research on Dental Implants (CEPID). Alterations of color, shape, and position were observed on the anterior maxillary teeth. For proper treatment planning, radiograph, wax-up, and mock-up were performed. Second stage surgery was performed by the U-shape flap technique. A trunnion abutment was installed at the implant and a provisional subcontoured cemented crown was manufactured. Dental bleaching, feldspathic veneers, and a ceramic crown were performed. Oral hygiene instructions were recommended. Follow-up appointments were set at 1.5 and 3 years after restoration placement. After 3-year follow-up, soft tissue stability and health were preserved and papillae coronal migration around the single dental implant was observed. A complication-free treatment was reached, and patient demonstrated satisfaction towards esthetic and function.

CONCLUSIONS

The use of U-shape technique at second stage surgery associated to adequate prosthetic contour improved soft tissue esthetic outcomes, while the multidisciplinary treatment planning provided adequate solutions, refining harmony between dental and implant-supported components.