Management of peri-implant soft tissue dehiscence with combined prosthetic-surgical approach: A case report

Abstract

BACKGROUND: This case report presents the management of an esthetic complication of a peri-implant soft tissue dehiscence (PSTD) through a combined prosthetic-surgical approach. METHODS AND RESULTS: A 53-year-old healthy Hispanic male presented to our practice for the treatment of an implant esthetic complication. A diagnosis of PSTD class III C was established. The abutment and crown were first modified to accommodate the tissue graft and support the coronally advanced flap (CAF). Then, a CAF with tuberosity connective tissue graft was performed. A definitive abutment and crown were fabricated 8 months after healing. Significant improvement of the PSTD, improvement of the peri-implant soft tissue dimensions, and patient satisfaction have been achieved. CONCLUSION: A combined prosthetic-surgical approach constitutes a valid treatment modality for PSTD class III C where there is abundant interproximal tissue available. KEY POINTS: Integrated treatment approach: A combined prosthetic-surgical technique offers an effective solution for managing peri-implant soft tissue dehiscence (PSTD), ensuring improved tissue thickness and stability. CLINICAL CONSIDERATIONS: The bucco-lingual implant position and interproximal tissue quality are key factors in determining the optimal treatment strategy. Predictable outcomes: Coronally advanced flap combined with connective tissue grafting can enhance esthetic and functional results for management of PSTD. PLAIN LANGUAGE SUMMARY: Peri-implant soft tissue complications can affect both the function and appearance of dental implants. This case study explores an approach that combines surgical and prosthetic techniques to improve the gingival tissue surrounding an implant. A 53-year-old patient had an esthetic concern due to gum recession around his implant. To correct this, his dental crown and abutment were adjusted. Then, a gingival grafting procedure to reposition the gingival tissue and enhance its thickness was performed. After healing for eight months, the implant was permanently restored with a final crown. The results showed significant improvements in gingival tissue health, thickness, and appearance, leading to patient satisfaction. The findings highlight how combining surgical techniques with prosthetic adjustments can help manage similar cases, offering a predictable solution to improve both the appearance and stability of dental implants.