The importance of soft tissue management around implants

02 February 2024

Soft tissue management around dental implants is an important aspect of the treatment modality. There is a body of evidence demonstrating that key features of the peri-implant tissues impact the aesthetic and health outcomes of treatment. As such, clinicians providing implant therapy must be confident assessing the soft tissues and minimising the risk of related complications, which often includes the provision of soft tissue grafting procedures.

As a Specialist Periodontist, this is something that Dr Joel Thomas is passionate about. He is particularly keen to promote the topic among colleagues who are new to dental implants, commenting:

“Clinicians often come out of implant training with relatively low confidence in soft tissue surgical management techniques and how to use them effectively. From early in their implant careers, clinicians need to know how to identify, diagnose and plan for providing optimal soft tissue around their implants. By acquiring the skill and confidence required to avoid and treat potential soft tissue deficiencies, dentists reduce the need to refer and increase their chances of success in a broad range of implant cases.”

 

As part of his mission to enhance training for soft tissue management around implants, Joel discussed the topic and offered a wealth of practical hints and tips during his session at the the ADI Next Gen Masterclass 2024. There was also ample opportunity for delegates to gain hands-on experience, as Joel took them through the fundamentals of soft tissue augmentation and how to use these techniques effectively. He says:

“One of the biggest causes of problems for clinicians who are new to implants, is the failure to identify potential complications associated with the soft tissue in the initial assessment. In particular, we need to be evaluating the thickness, quality and biotype of the soft tissue, as these will have a significant impact on the aesthetic outcome that can be achieved. They will also influence the risk of peri-implantitis developing in the future, which is something that the patient needs to be made aware of.

“Beyond the initial consultation and assessment, the soft tissues should be monitored carefully throughout the implant treatment stages. In an ideal situation, we would want to see thick, keratinised and attached tissues around each implant at the time of fitting the crown. Where this does not form, augmentation may be indicated prior to fitting the final crown.

“The goal should always be to manage the soft tissues as early in the treatment process as possible, creating maximum opportunities for review and further augmentation if needed. This also helps to avoid extending the overall treatment time.”

 

Though he has developed expertise in soft tissue augmentation and advanced management techniques, Joel highlights that prevention is still better than cure.

“It is much better to persevere the soft tissue in the first place than to augment it later,” Joel continues. “For example, if a tooth is present, extraction should be as atraumatic as possible. If using a delayed implant placement approach, then socket preservation will likely be beneficial.”

 

When the soft tissue is found lacking and augmentation indicated, there are various treatment solutions to choose from. Firstly, the clinician must decide when to perform grafting procedures, whether prior to, simultaneously with or after implant placement and/or restoration. Several augmentation techniques are available to the dentist, each offering unique advantages according to the clinical situation. Joel adds:

“The most common soft tissue augmentation solutions include autogenous grafts and tissue replacement therapies. These each have different indications and should be selected carefully based on the tissue characteristics.”

“The only real contraindications for any soft tissue grafting are medical issues or consequential medications that would impact the surgical procedures, heavy smoking and poor oral hygiene.”

 

For dentists looking to move into the implant arena, or who have already taken their first steps and wish to progress safely and effectively, Joel offers some advice:

“It’s really important to find a good mentor when you start out, who can guide you through your first few cases – with a particular emphasis on diagnosis and treatment planning. It is also vital to start simple and seek out additional training early on in your professional development so you are better able to identify suitable cases according to your skill level.

“I have found my membership with the ADI to be hugely beneficial. The association provides access to an invaluable network of experienced clinicians who can advise on all sorts of difficulties you may encounter. There is a wealth of knowledge to be tapped into as you embark on increasingly complex cases. The resources available on the ADI website are also very helpful to deliver clinically effective and medicolegally safe implant dentistry. I use a lot of the consent forms and patient information leaflets. The standard of the conferences and courses run by the ADI has also always been very, very high.”

 

If you are new to dental implantology or looking to advance your skills in the field, the ADI offers the opportunity, inspiration and support to do so successfully. Find out more about joining and the various membership benefits available today!

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