Aesthetic Management of Peri-Implant Soft Tissue Dehiscence. A Case Report of a Combined Perio Restorative Approach

This case report designates a combined perio restorative technique in the management of peri-implant 3-dimensional soft tissue defects in an esthetic zone. A staged approach was implemented to treat this case; the first stage was planned to treat the horizontal defect around the implant, in which crown was removed, and coronally advanced flap with connective tissue graft were used to treat the soft tissue defect. At the second stage, a modified coronally advanced flap with connective tissue graft was used to augment the vertical defect, and no vertical releasing incision was made in this stage to maximize the blood supply to the advanced flap. De-epithelized free gingival graft was harvested from the palate to obtain better fibrous connective tissue graft . Graft was placed over the site to compensate for the vertical defect and flap was advanced to ensure primary closure without tension. Resin-bonded bridge was used as a provision after modification to avoid any soft tissue contact. Healing by primary intention was attained providing a clinically healthy soft tissue surrounding a well-functioning restoration, and periapical radiographs showed a stable crestal bone level without presence of mucositis or peri-implantitis. Within the limitations of this clinical case report, it revealed the possibility of fully restoring severe horizontal and vertical peri-implant soft tissue defects and at the same time attaining high level of patient satisfaction via a combined mucogingival and prosthetic approach; nevertheless, the long-term preservation of this successful outcome needs to be monitored.