Stephen Yeung

Biological basis for soft tissue management in implant dentistry.

Good aesthetic finish of implant/restorations requires healthy peri-implant soft tissue at the appropriate location. The relevance of the peri-implant soft tissue seal, the biological width, the keratinized gingival zone and the need for effective plaque control in order to maintain peri-implant soft tissue health were discussed. The presence of a soft tissue seal/cuff around dental implants and abutments and its role in defense against infection were convincingly demonstrated in animal studies. In order to achieve long-term stable peri-implant health, it is important to achieve an adequate soft tissue seal around dental implant/restorations. The constant dimension of a biological width (of the soft tissue) often dictates where the final gingival margin will be. It is therefore not surprising that the position and stability of the alveolar bone ridge surrounding dental implants ultimately determines where the gingival margin rests. For dental implant restorations in the aesthetic zone, this is a crucial variable for the clinician to understand and deliver. Available data so far suggest that with good oral hygiene, peri-implant soft tissue health can be maintained irrespective if a keratinized gingival tissue zone surrounding implant/restoration is present. In reality, good oral hygiene is very difficult to achieve around dental restorations without the protection of a band of keratinized gingival tissue. Studies on peri-implantitis and peri-implant mucositis further demonstrated the causal relationship between dental plaque accumulation and peri-implant inflammation. It is therefore imperative that long-term maintenance care of dental implants and implant supported dental restorations should include a strict regime of plaque control and monitoring.

Do dental implants preserve and maintain alveolar bone

Dental implants have been touted as capable of playing an active role in the maintenance of alveolar bone height, despite the lack of a sound biological basis to support this proposition. This paper reviews the biology of bone loss, the literature concerning alveolar bone remodeling in both the postextraction period and long term, and discusses the literature regarding the influence dental implant placement has on this process. Based on current evidence, implants do not have an active role in the preservation and maintenance of alveolar bone height. Following extraction of a tooth, no external influence has been identified that will prevent loss of bundle bone or alveolar bone remodeling. Additionally, the magnitude of change is patient, site, and time dependant. Further supporting evidence is required before it can be concluded that dental implants are capable of influencing alveolar bone remodeling.