M421Surgical Techniques to EnhanceFunctional and Aesthetic Dental ImplantSuccessSteven Guttenberg, DDS, MD, Washington, DC

As the art and science of implantology have matured,the sophistication of implant prosthetics has forced sur-geons to recognize and deal with anatomic shortcomingspresented to them by the patient. No longer is it appro-priate to place implants where the bone exists without athorough restorative evaluation.

Once prosthetic reconstruction is outlined, the sur-geon will be confronted with placing the implantswhere they can be best used to replace the missingteeth, using functional and aesthetic parameters. Often-times, this may not occur without alteration of the exis-tent anatomy. This may be accomplished by nongraftingtechnology, such as bone expansion and the use ofmembranes, or by grafting with autogenous bone as wellas osteoproductive allografts and xenografts. Reposition-ing of the inferior alveolar nerve may also provide theosseous dimensions necessary to house mandibular im-plants.

Technological advances continue to provide new andimproved ways to modify the shape and volume of themaxilla and mandible. For example, alveolar distractionosteogenesis and the use of growth factors have becomecommonplace.

In the near future, other biotechnologies such as theuse of bone morphogenic protein should provide rela-tively noninvasive modalities to create bone where it nolonger exists.

M422Pharmacology Update for the OMSKaren Baker, MD, Iowa City, IA

(no abstract provided)

M423Periodontal Plastic Surgery for theImplant PatientAnthony Sclar, DMD, Miami, FL

Modern periodontal plastic surgery evolved from tra-ditional resective periodontal surgery as a result of thedevelopment of various reconstructive and regenerative

surgical techniques. The impetus for these surgical andbiotechnological developments was an increased publicawareness and demand for aesthetic dental services.Today periodontal plastic surgery techniques fall underthe realm of “cosmetic periodontal surgery” and “aes-thetic implant site development,” having applications incosmetic dentistry as well as implant therapy. Theseprocedures are “plastic” in nature and are used to man-age vestibular insufficiency, aberrant frenum, marginaltissue recession, excessive gingival display, lost interden-tal papillae, and deficient alveolar ridges, as well as topreserve alveolar hard and soft tissues following toothremoval in preparation for implant therapy or conven-tional prosthetic restorations.

An anatomic basis exists for the successful applicationof these techniques to both periodontal and peri-implanthard and soft tissues. Most important, the clinician mustunderstand that the peri-implant soft tissues lack a con-nective tissue attachment to the permucosal implantstructures and do not enjoy the blood supply normallyderived from the periodontal ligament around naturalteeth. In addition, the peri-implant soft tissues do notenjoy the potential vascular anastomotic connectionspresent in the periodontal soft tissues. These importantanatomic differences render the peri-implant soft tissuesmore vulnerable than periodontal tissues to mechanicaland bacterial challenges and can limit the soft tissuevolume yielded from the various soft tissue reconstruc-tive procedures performed at implant sites.

Nevertheless, soft tissue preservation and reconstruc-tive techniques can be used not only to enhance theaesthetic results obtained in the partially edentulousimplant patient but also to improve the functional resultsobtained when implant therapy is used to treat theedentulous patient suffering from alveolar atrophy. Ap-plication of these techniques in implant therapy requiresa meticulous surgical technique and strict adherence tothe basic principles governing oral soft tissue graftingprocedures. With an understanding of periodontal andperi-implant soft tissue anatomy and the principles oforal soft tissue grafting, the clinician can select, se-quence, and successfully apply soft tissue grafting tech-niques to enhance functional and aesthetic results inimplant therapy. Furthermore, cosmetic periodontal sur-gery can be used to create harmony between implantrestorations and the remaining natural dentition.

References

Bauman GR, Rapley JW, Hallmon WW, et al: The peri-implant sulcus.Int J Oral Maxillofac Implants 8:273, 1993

Miller PD: Regenerative and reconstructive periodontal plastic sur-gery. Dent Clin North Amer 32:287, 1988

Sclar AG: Cosmetic soft-tissue enhancements for dental implants.Alpha Omegan 93, August/September 2000

Surgical Mini-Lectures

104 AAOMS • 2003