Topic: NOVEL APPROACHES AND STRATEGIES FOR PERI-IMPLANT SOFT TISSUE AUGMENTATION: WHY, WHEN AND HOW.

Endosseous dental implants have been used successfully for decades to replace missing teeth or teeth with poor prognosis. As long as the implants are inserted following a 3D prosthetic driven direction and surrounded by a minimum volume of bone matrix the implant treatment can be safely considered long-lasting. However the fact that an implant is properly functioning is not necessarily associated to success. In fact, many dental implants can present esthetics or functional alterations in the soft tissues morphology and texture that jeopardize the success rate of the therapy. Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional critical issues. Treatments of these defects around implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. Recent studies have shown that the peri-implant mucosa can play a major role in the sealing of the implant platform thus preventing bacterial ingrowth. A good quality, quantity and thickness of the peri-implant soft tissue is also critical to achieve biomimetics and pink esthetics. It has been reported that about one third of the inserted implants may then require a connective tissue graft. However, this approach could be considered too invasive when multiple implants need to be treated with mucogingival plastic procedures. The “Buccal Pedicle Flap” and its modifications will be presented as a novel technique to boost the peri-implant mucosa without the need of invasive procedures thus allowing to obtain the desiderable mucosa volume and quality. This approach would lead to a more stable tissues, no peri-implant bone loss or peri-implantitis and ultimately higher success rate in modern implant dentistry.