Dr. Justin Moody discusses the importance of soft tissue evaluation
Today in implant dentistry, we are starting to see the true importance of soft tissue architecture, not only at the time of implant placement, but also for the long-term esthetic survival of the restoration. In my practice, I have seen the changes in soft tissue manipulation or lack thereof, and I can tell you that we all learn from our mistakes and experiences.
When I first started placing implants nearly 20 years ago, I only used a two-stage technique and always uncovered my implants with an incision not removing any tissue. As time continued, I started to look at less invasive techniques such as a tissue punch or laser; this was often less traumatic to the patient, but what about the tissue? Those techniques remove the most valuable thing we have — keratinized tissue. It is important to note that there are some instances, like in the posterior maxilla where the tissue is already super thick, that you can use these methods. However, in the esthetic zone, where tissue is king, and the papilla rules, we need all that we can get. I was recently teaching a guided-surgery course where I was showing a case involving a flap being laid first prior to the guide. A doctor raised his hand and said, “That’s exactly why I am learning about guides so that I don’t ever have to make a flap again.” It was then that I knew we needed to discuss this.
The long-time edentulous mandible is one of the areas in which we see a total lack of keratinized tissue. It is here that I get the most emails asking what to do when a locator abutment is coming out of paper-thin tissue, and the patient is complaining of pain and discomfort. Many times, this patient has adequate bone, and we jump straight into the placement, not thinking of the long-term effects of the absence of tissue. The referral to a periodontist may seem like a case killer, but in the long-term, it could be the difference between seeing the patient once every 6 months for re-care or every week with a problem. Soft tissue evaluation during the implant workup is a must; it just makes