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promising results. non-matching implant-abutment diameters in the canine
If we are presented with sufficient keratinized tissue at a certain location mandible. J Periodontol 2009: 80: 609–617.
but need to shift it to the area of interest then apically positioned flap, rotated 7. Schneider D, Grunder U, Ender A, Hammerle CH, Jung
pedicle flap or laterally positioned flap are the procedures that would be RE. Volume gain and stability of peri-implant tissue
beneficial. following bone and soft tissue augmentation: 1-year results
from a prospective cohort study. Clin Oral Implants Res
DiSCUSSiON 2011: 22: 28–37.
The absence of keratinised mucosa and vestibular depth has been speculated 8. Dawson A, Chen ST, Buser D, Cordaro L, Martin W, Belser
to play a significant role in the development and aggravation of peri- U. The SAC classification in implant dentistry. In: Dawson
implant inflammation. Consequently, some patients may require additional A, Chen ST, editors. Quintessence Publishing Co, Ltd,
surgical procedures, which may be performed simultaneously with implant 2009: Berlin.
placement or staged, in order to improve the condition of their peri- implant 9. Grossberg DE. Interimplant papilla reconstruction: assess-
soft tissue. Studies on autogenous soft-tissue grafts have demonstrated ment of soft tissue changes and results of 12 consecutive
significant increases in peri- implant keratinised mucosa width, peri- cases. J Periodontol 2001: 72: 958–962.
implant soft-tissue thickness and peri-implant supra-crestal tissue height. 10. 37. https://doi.org/10.3390/ma15113937
However, the need for additional surgical sites, postoperative discomfort, 11. Linkevicius, T., Apse, P., Grybauskas, S., & Puisys,
and inadequate control over the quality and quantity of tissue can potentially A. (2009). Reaction of crestal bone around implants
compromise clinical outcomes. depending on mucosal tissue thickness. A 1-year
Allogeneic dermal matrix, xenogeneic collagen matrix cross-linked and prospective clinical study. Stomatologija,11(3), 83–91.
non cross-linked along with acellular porcine dermis have been proposed as
alternatives to autogenous soft- tissue grafting as a means of bypassing these
limitations. Allogeneic dermal matrices come in varying thickness, and
selecting the appropriate thickness for a particular procedure can be critical.
Using a graft that is too thick or too thin for the intended purpose can lead to
suboptimal results. Several studies on porcine-derived collagen substitutes
have shown favourable clinical outcomes in peri-implant soft-tissue surgery.
Since these collagen matrices maintain their mechanical stability, they are
able to support cell adhesion, cell proliferation and blood vessel ingrowth,
resulting in keratinized functional tissue.
It may be concluded that the options available to a clinician regarding
choice of procedure and biomaterials are varied and choosing the right
technique with optimal biomaterials would result in acceptable clinical ABOUT THE AUTHOR
outcomes. n
Dr. Yazad Gandhi completed
REFERENCES his masters in Oral and
1. Thoma, D. S., Naenni, N., Figuero, E., Hammerle, C. H. F., Schwarz, F., Maxillofacial surgery from
King George’s Medical College
Jung, R. E., & SanzSanchez, I. (2018). Effects of soft tissue augmentation and followed it up with an
procedures on peri-implant health or disease: A systematic review and advanced training in bone
meta-analysis. Clin Oral Implants Res, 29 Suppl 15, 32-49. doi:10.1111/ and soft tissue surgery at
clr.13114 the Goteborg University,
2. Wennström, J. L., & Derks, J. (2012). Is there a need for keratinized Sweden. He has trained for
mucosa around implants to maintain health and tissue stability? Clinical endoscopic sinus surgery
Oral Implants Research, 23(s6), 136–146. https://doi.org/10.1111/j.1600- at the Ninewells Hospital,
0501.2012.02540.x Dundee. He is a fellow of the ITI
3. Buser D, Mericske-Stern R, Bernard JP, et al. Long-term evaluation and The International college
of non-submerged ITI implants. Part I: 8-year life table analysis of a of dentists. He is a KOL for
Geistlich, Biohorizons, Versah
prospective multi-center study with 2359 implants. Clin Oral Implants and Medesy. He remains on the
Res 1997;8:161–172. board of reviewers for multiple
4. Carmichael RP, Apse P, Zarb G, McCulloch CAG. Biological, international journals and has
microbiological and clinical aspects of the peri-implant mucosa. In: several publications to his
Albrektsson T, Zarb GA, eds. The Branemark Osseointegrated Implants. credit in international journals.
Chicago: Quintessence, 1989:39–78. He is a co-director of Fusion
5. Berglundh T, Lindhe J. Dimension of the peri-implant mucosa. Education, an organisation
Biological width revisited. J Clin Periodontol 1996;23:971–973. that conducts CDE courses for
6. Cochran DL, Bosshardt DD, Grize L, Higginbottom FL, Jones AA, dentists.
Jung RE, Wieland M, Dard M. Bone response to loaded implants with

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