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Inside Dentistry
December 2023
Volume 19, Issue 12

Ensuring Sufficient Attached Gingiva Around an Implant

A simple surgical procedure to resolve a common problem

Timothy Kosinski, DDS | Stephanie Tilley, DMD

As teeth are lost, it is common for bone loss to occur, which can be followed by the loss of mucosal tissue and result in a lack of attached gingiva on the facial aspect of edentulous sites. Oftentimes, a band of attached gingiva can be repositioned with a simple surgical procedure using a sling suture around a healing abutment. In this procedure, the gingiva is sutured around the healing abutment and not onto the lingual tissue at all.

Stable gingival margins are critical to the health of dental implants. The attached gingiva provides protection from external trauma, creates stability for the adjacent soft tissue, and is essential for proper tissue healing around dental implants. Without sufficient keratinized attached gingiva, food impaction may occur as well as tissue shrinkage, which can affect the long-term prognosis and esthetics of an implant-supported restoration. In addition, the penetration of bacteria can compromise the long-term health of dental implants; therefore, sufficient keratinized tissue is critical in areas of the mouth where plaque control may be challenging.

The gingiva around dental implants needs to be firm and attached, otherwise the physiologic pattern of health may be broken. Hemidesmosomal fibers, which are normally about 1-mm long, attach the junctional epithelium to the teeth or implants, and the oral sulcular epithelium is connected to the junctional epithelium. Subjacent to the junctional epithelium is a layer of connective tissue that is approximately 1-mm thick. Unlike around teeth, where the connective tissue fibers are perpendicular to the root surfaces and insert into the cementum, around implants, the fibers are parallel or oblique and do not insert into the implant surface. The blood supply around implants is also less than around teeth because there is no periodontal ligament around implants. Learning to control the positioning of attached gingiva, such as how it is managed in this case report, is a significant treatment modality that facilitates a natural emergence profile, correct function, and appropriate hygiene while delivering restorative excellence.

About the Authors

Timothy Kosinski, DDS
Academy of General Dentistry
International Congress of Oral Implantologists
Affiliated Adjunct Clinical Professor
University of Detroit Mercy
School of Dentistry
Detroit, Michigan
Private Practice
Bingham Farms, Michigan

Stephanie Tilley, DMD
International College of Dentists
International Congress of Oral Implantologists
Private Practice
Pensacola, Florida

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