Soft tissue condition and morphology

Once an implant is placed in function, peri-implant mucosal changes had been postulated as an attempt of the mucosal tissue to establish a stable biological dimension. If the thickness of peri-implant mucosa is reduced, bone resorption occurs to reestablish the mucosal dimension that was required for protection of the underlying tissues.

The influence of mucosal thickness and biologic width formation on tissue health maintenance and bone wall preservation around implants is today considered one of the most important concern for both function and esthetics. The term periodontal biotype was introduced by Seibert and Lindhe to describe the thickness of the gingiva in the faciopalatal dimension, and this is an important aspect in the maintenance of gingival health. It has been suggested the existence of a direct correlation between gingival biotype and the susceptibility to gingival recession around dental implants. Furthermore, the importance of the thickness of the alveolar ridge mucosa underneath a zirconia implant-supported restoration has been recently introduced, suggesting the existence of a physiological barrier underneath a implant-supported bridge restoration. These dimensions support the concept that the clinician may prepare the pontic recipient site in order to ensure an adequate mucosal thickness to properly house the prosthetic interface.

Although an objective classification of the gingival tissue thickness of different biotypes has not been defined, gingival biotype can be evaluated as follows:

• Direct visual assessment only;
• Visual assessment with the aid of a periodontal probe;
• Direct measurements, combining the previously methods;ef
• Measurements using the cone bean computer tomography.

 
Recently soft tissue cone-beam computed tomography combined with SmartFusion (Nobel Biocare, AG) technology is used to visualize, measure the dimensions, and analyze the relationship of several structures of the periodontium and dentogingival attachment apparatus. Furthermore, this method allow the determination of the dimensions and relationships of the structures of the dentogingival unit (figures).

Figure 1 Figure 2  Figure 3  

Maxillary implant placement (Figure 1). Three years clinical (Figure 2) and radiographic view (Figure 3).

Figure 4 Figure 5 Figure 6   Mandibular implant placement (Figure 4). Three years clinical (Figure 5) and radiographic view (Figure 6)

Figure 7: Measurement of the soft tissue thickness using SmartFusion technology