Soft-Tissue Thickness Augmentation

Soft-tissue grafting procedures are performed for a variety of clinical indications to increase the soft-tissue volume under pontics or around dental implants or natural tooth, i.e. mainly for esthetic purposes, based on the mucosal biotype and patient expectations.1-4 Thin mucosal biotypes are more prone to functional or esthetic dysfunctions as compared with thick biotypes. Soft-tissue augmentations contribute to more than 40% of the final soft-tissue volume at implant sites3, result in superior esthetics, more stable soft-tissue dimensions and contribute to more stable bone levels at implant sites.1-5

Autogenous connective tissue grafts (CTG) are used to augment soft-tissue volume and according to the literature are considered to be the gold standard.1-6 However, these procedures are time-consuming and painful for the patients.

The new volume-stable collagen matrix, Geistlich Fibro-Gide®, is the alternative to autogenous CTG and avoids the disadvantages of harvesting grafts and thus, post-operative pain and potential post-operative complications may be reduced.6-9Clinically, soft-tissue volume augmentation with Geistlich Fibro-Gide® is comparable with connective tissue grafts.1-6

Clinical case: Increased soft-tissue thickness around a single implant with Geistlich Fibro-Gide®.

Baseline frontal view: missing central incisor. Implant visible through mucosa due to thin biotype.
Baseline occlusal view: soft-tissue deficit in the buccal and occlusal area
Flap elevation on the buccal side using a full flap crestally and a split flap buccally.
Adaption of Geistlich Fibro-Gide® (15 × 20 × 6 mm) to the defect size.
Palatal island flap prepared to allow for tension-free wound closure. Geistlich Fibro-Gide® in situ, immobilized with a mattress suture.
Tension-free wound closure using single interrupted sutures (Dafilon 5-0, Braun).
Suture removal 7 days post-surgery.
Abutment connection.
6 months follow-up: final crown in place.

Case by PD Dr. Daniel Thoma (Zurich, Switzerland)

REFERENCES
  1. Studer SP. et al. J Prosthet Dent. 2000 Apr;83(4):402-11.
  2. Kinsel RP & Capoferri D. et al. Pract Proced Aesthet Dent. 2008 May;20(4):231-6; quiz 237.
  3. Schneider D. et al. Clin Oral Implants Res. 2011 Jan;22(1):28-37.
  4. De Bruyckere T. et al. J Clin Periodontol. 2015 Sep;42(9):876-82.
  5. Zeltner M. et al. J Clin Periodontol. 2017 Apr;44(4):446-453.
  6. Thoma DS. et al. J Clin Periodontol. 2016 Oct; 43(10): 874–85.
  7. Sanz M. et al. J Clin Periodontol. 2009 Oct; 36(10): 868–76.
  8. Del Pizzo M. et al. J Clin Periodontol. 2002 Sep; 29(9): 848–54.
  9. Soileau KM. & Brannon RB. J Periodontol. 2006 Jul; 77(7): 1267–73.
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