Soft tissue-related complications and management around dental implants. Part 1

This presentation by Dr. Pavel Yarashevich, presented at the FOR Greater China Symposium 2024, provides an in-depth exploration of soft tissue management around dental implants, focusing on clinical strategies to enhance both aesthetic and functional outcomes. Dr. Yarashevich begins by introducing himself and the topic, emphasizing the significance of tissue-related complications in daily implant dentistry. He frames the presentation as a progression from simple to complex cases, highlighting the need for careful tissue handling to ensure long-term success.

Throughout the presentation, Dr. Yarashevich outlines his clinical approach, which centers on resolving soft tissue issues often without resorting to extensive bone grafting. His practice focuses on periodontology, implantology, and particularly the management of soft tissue complications. He underscores that many aesthetic and functional challenges—such as interdental papilla loss or exposed implant threads—can be effectively addressed with soft tissue augmentation alone. He explains that enhancing the quality and volume of soft tissue can in many cases provide sufficient stability and aesthetic improvement, reducing the need for more invasive surgical interventions.

A compelling clinical case is then presented, involving an implant with exposed threads. Dr. Yarashevich details the diagnostic process and the decision-making pathway that led to choosing implant preservation over removal. He stresses the importance of assessing the soft tissue phenotype and understanding how the condition and thickness of the surrounding mucosa influence implant survival. His approach involves careful evaluation of tissue volume, implant positioning, and overall prognosis before determining the treatment strategy.

The presentation moves into a discussion of soft tissue augmentation techniques. Dr. Yarashevich explains how the use of connective tissue grafts, particularly those harvested from the tuberosity area, can increase mucosal thickness and encourage spontaneous keratinization. He references recent research that supports the relationship between mucosal thickness and the development of keratinized tissue, emphasizing that the presence of keratinized mucosa is not only beneficial but often necessary for the long-term health of the peri-implant environment. He also points out that augmentation techniques must ensure the proper interaction between graft and flap epithelium to optimize healing and integration.

A detailed case study follows, showcasing his soft tissue augmentation protocol using an epithelial-embossed connective tissue graft. He demonstrates the formation of a partial thickness flap and highlights the importance of ensuring contact between the epithelium of the graft and the primary flap. The results, as shown post-operatively, include a substantial increase in both soft tissue volume and keratinization, with improved aesthetic contours and tissue health.

In the final portion of the presentation, Dr. Yarashevich addresses immediate implant placement. He outlines the clinical protocol and the critical factors required to achieve predictable results in such cases. Emphasizing both bone and soft tissue considerations, he explains how immediate implant protocols can be successfully executed when there is precise control over tissue management. He advocates for the use of NobelParallel implants to achieve both aesthetic and functional success, while integrating connective tissue grafting and, when needed, bone augmentation. Dr. Yarashevich presents long-term follow-up data that support the durability and reliability of immediate placement when performed with careful tissue planning.

In conclusion, Dr. Pavel Yarashevich delivers a comprehensive and clinically relevant presentation that underscores the pivotal role of soft tissue in implant dentistry. His work demonstrates that with proper techniques and protocols, clinicians can manage complex implant cases, reduce the need for bone grafting, and deliver superior outcomes through effective soft tissue augmentation. This presentation serves as a valuable resource for dental professionals aiming to elevate their practice in implant aesthetics and long-term treatment stability.