Soft-tissue collar around implants: A periodontal compromise or not?

The perfect analogy to use and consider, especially when speaking to patients, is the outer surface of the hand versus the palm of the hand. Both are skin, but which one is tougher? Obviously, the palm is.

That same analogy can and should be used when speaking to patients in order for them to understand the greater need of an additional treatment modality for the creation or recreation of the quality and type of soft-tissue drape.

For years this was a very complex and difficult procedure, usually only attempted by the very best of periodontists and with mixed results. Later, with the inclusion of certain tissue-derived products, these alternatives have become simpler and more available to the masses. These materials have proven to be very effective and they have been redeveloped over time as the manufacturers and processors continue in their attempts at the very best and most reliable materials.

 

The most common of these materials are Alloderm by BioHorizons, and Dermis by Zimmer and Tutogen. These materials have been around for quite some time and provide good results. Each has some drawbacks, though, such as tearing and tissue odor during the healing phases.

The “new kid on the block” is Grand Dermis by CK Dental Industries. This human allograph product seems to have handled the previous drawbacks and has also shown no foul odor, which patients enjoy over the previous product.

The techniques and product improvements are designed for the dental surgeon to have better predictability and ease of use. The practitioner can use this product in simple or complex cases.

For instance, use it as a membrane in socket-grafting procedures. It will protect the graft better than traditional membranes; it is able to be sutured and will not tear. After healing, the tissue quality and quantity will also be improved. The product offers all of these benefits while being less expensive than most membranes of similar size.

Case No. 1

This case was a 15-year-old implant and crown restoration done during the early years of implant restoration. It was a very long implant, firmly embedded and showing no signs of pathology.

The patient’s concern was mostly esthetics and the “black line” visible near the neck.

Upon closer inspection, I also noticed a thin mucosa at the cervical with a slight depression.

Corrections included:

• New crown with a slightly longer margin.
• Cervical tissue bio-type improvement and plumping with Grand Dermis.

Case No. 2

This case was of a young woman with failing lower right dentition from fear and poor dental choices. The patient accepted treatment under sedation. Extraction of root tips took place with bone grafts and Grand Dermis overlay was done at the same time.

Tissue tacks were used in this case to better support and immobilize the tissue cover. Notice the minimal connective tissue around the root tips and the thin bio type.

Corrections included:

• Extraction and graft of all sockets using CK Dental mineralized bone allograph.
• Grand dermis overlay and tack down.
• Implant and crowns as final restorations.

Conclusion

These cases are typical of daily cases seen or avoided in many clinical settings across the country. No longer does this or should this go on.

Patients and clinicians alike can have better results with improved longevity and periodontal success with this material.

In my opinion, Grand Dermis has improved an already wonderful product and treatment option.

(For ordering information, contact CK Dental Industries.)

About the author

Dr Nilo Hernandez has been a well-respected dentist for many years and has long been involved in helping dentists improve their practices by training and assisting in many different ways. This help has included both clinical and administrative ways of improving their daily practice of dentistry. For many years, he helped develop many different implant practices and training centers across the United States. Dentists call his practice on an almost daily basis for assistance. A graduate of Creighton University School of Dentistry in Omaha, Neb., Hernandez is a general dentist in private practice in Miami. He has been involved with implant dentistry since 1990 and has performed several thousand dental implant procedures. For additional information or comments, contact Hernandez at nilo@idecseminars.com.