Eric Rompen: How to optimize transmucosal health and maintain tissues in the posterior region

To maintain transmucosal health and tissue stability a main objective is to avoid apical migration of peri-implant tissues, and thus to prevent pocket formation, inflammation and bone loss. Dr Rompen discusses the clinical and material aspects which play a role for soft tissue esthetics and stability, such as the tissue seal via the biological width, material biocompatibility and cleanliness, cementation of prosthetic components, soft tissue biotype and management. To avoid alteration of the tissue seal, abutments ideally should be placed only once and not disconnected, alternatively tissue level implant designs can be selected, or bone level implants with immediate one time placement of Multi-unit Abutments. To benefit from non-mobile soft tissues, a minimum of 2 mm of keratinized mucosa and a concave transmucosal emergence design is preferred, supported by platform-shift implant design concepts. Dr Rompen explains the NobelActive WP and Nobel Parallel CC WP implant concepts, the Zirconia full contour crown and the Angulated Screw Channel concept (ASC) - a comprehensive posterior screw-retained solution. Dr Rompen concludes and suggests, that in order to obtain tissue adhesion it is important to use biocompatible materials, and in order to preserve the soft tissue seal to reduce prosthetic component disconnections and to avoid sub-mucosal cement.