Forum Implantologicum, 02/2016

Keratinized mucosa belongs to the masticatory mucosa, while nonkeratinizing mucosa belongs to the lining mucosa. Dental implants may be installed in either of these mucosal types. For the long-standing stability of the peri-implant mucosal tissues it is debated whether a band of keratinized mucosa surrounding the implant is needed. Increasing evidence from recent well-designed clinical studies points to that necessity. Hence, it may be anticipated that in certain cases the band of keratinized mucosa needs to be widened to at least 2 mm. Schlagwörter: Keratinized mucosa, dental implant

Dental implants have proven to be a successful treatment option in fully and partially edentulous patients, rendering long-term functional and esthetic outcomes with peri-implant tissue stability. Apart from regenerative procedures on the level of the bone, an optimization of the peri-implant soft tissues is desired. These procedures are usually performed prior to implant placement or prior to the prosthetic phase. Various surgical techniques were described to augment soft tissue volume and keratinized tissue around dental implants including the use of autogenous grafts and soft tissue substitutes. Schlagwörter: Soft tissue augmentation, keratinized tissue, substitute, xenogenic, autogenous, dental implants

Peri-implant mucosal recessions are a common complication in implant dentistry and usually occur at later stages following implant placement thus negatively affecting oral hygiene measures, esthetics and, subsequently, patient satisfaction. Despite its increasing prevalence, the scientific evidence for the treatment possibilities of peri-implant mucosal recessions is still extremely limited. The aim of the present paper is, therefore, to review the potential etiological factors, the rationale for treatment and possible treatment options for facial peri-implant mucosal recessions.The limited available data suggest that only shallow periimplant mucosal recessions (e.g. up to 2 mm) may be successfully covered by using a coronally advanced flap (CAF) combined with either a subepithelial connective tissue graft (SGCT) or GBR. At present no data are available on successful coverage of deep and large peri-implant mucosal recessions. Schlagwörter: Dental implants, mucosal recessions, recession coverage

Soft tissue management has become a crucial part of implant therapy in the esthetic zone, as implant placement nowadays requires not only functional success, but also pleasing esthetic outcomes. New surgical techniques and materials provide clinicians with helpful tools that contribute to functional and esthetic success. More importantly, sophisticated clinical concepts are required to achieve the best possible result despite initially differing circumstances. During therapy, there are different points in time when it is possible to improve soft tissue conditions: at tooth extraction, together with implant placement or at uncovering. In the case of tissue deficits, augmentations using autologous soft tissue can be performed in different ways, such as socket seal surgery, the modified roll flap procedure or incisionfree tunneling techniques. Often not just one of them, but also a combination also have to be used subsequently at the different treatment steps. Once the desired soft tissue shape is created, it needs to be transferred from the provisional to the final restoration in the prosthetic part of the treatment. This article gives an overview of a strategic approach from tooth extraction to implant impression. Schlagwörter: Soft tissue, esthetic zone, implant placement, implant uncoverage

Local soft tissue deficits often follow tooth loss and implant therapy. Under these circumstances, future implant reconstructions should aim to completely or at least partially compensate this loss in order to minimize any adverse effects, namely compromising subjective patient comfort. In the main, this encompasses disconcerting food impaction, as well as esthetic and phonetic impairment. The present article reviews the relevant prosthetically driven compensation measures, confining itself to the esthetic zone of partially dentate implant patients and fixed dental prostheses (FDP). In this specific context five objectives are of paramount importance: (I) establishing healthy peri-implant soft tissues, (II) avoiding open embrasures, (III) maintaining or recreating a harmoniously scalloped soft tissue course, (IV) achieving the optical illusion of balanced relative tooth dimensions, and (V) providing ease of access for effective plaque control. Six representative clinical examples featuring various degrees of peri-implant soft tissue deficiencies are addressed in detail, highlighting different design guidelines and pointing out their inherent limitations. In the case of minorto- moderate soft tissue deficiencies, achieving the goal by implementing only morphological elements of the so-called white crown substrate such as adequate positioning of facial transition line angles and increased interdental contours is recommended. However, when facing major soft tissue deficiencies, the addition of pink ceramics as an integral part of the implant restoration may become unavoidable to achieve a clinically acceptable result. In this context one has also to take into consideration the position of a given patient's individual smile line as an important decision-making parameter. Schlagwörter: Peri-implant soft tissue, implant esthetics, soft tissue deficit, implant-prosthetic design, pink ceramics

"To serve the dental profession by providing a growing global network for life-long learning in implant dentistry through comprehensive quality education and innovative research to the benefit of the patient." The ITI mission statement certainly holds true for my Scholarship year at ACTA Amsterdam.

My time as an ITI Scholar has been one of the most inspirational and meaningful experiences for me, both professionally and personally. Being part of the ITI family and Scholarship program is a very unique professional experience. One becomes part of a close-knit community of likeminded clinicians from different fields, but with the same philosophy.