Sangkhamanee Sujiwan Seubbuk, Teparat-Burana Thitiwan
Department of Oral Medicine and Periodontology Faculty of Dentistry Mahidol University, Bangkok 10400, Thailand.
Case Rep Dent. 2024 Aug 13;2024:5895661. doi: 10.1155/2024/5895661. eCollection 2024.
Soft and hard tissue deficiencies around dental implants which can potentially compromise implant survival are commonly encountered. Complicated interventions are often required to address and resolve combinations of soft and hard tissue defects. This case report describes the management of peri-implant soft tissue fenestration accompanied by bony dehiscence associated with intrabony defect through soft tissue modification. A 51-year-old female was referred to the Periodontics and Oral Medicine Clinic with labial soft tissue fenestration at the maxillary left canine implant-supported crown. The patient complained of discomfort and malodor at the implant site. The implant showed mucosal fenestration and 6 mm probing depth (PD) with profuse bleeding at the distolabial site without mobility. A cone beam computed tomography (CBCT) demonstrated labial bony dehiscence associated with a 5.56-mm intrabony defect at mesial and distal surfaces. The implant was diagnosed as peri-implantitis with soft tissue deficiency. The treatment comprised oral hygiene instruction, debridement of the implant and all natural teeth, and mucogingival surgery with free connective tissue graft by the envelope technique. Two weeks after debridement, the mucosal margin of the implant disappeared, presenting soft tissue dehiscence of 4 × 4 mm. Mucogingival surgery was performed 3 weeks later. A 2-year follow-up revealed a stable mucosal margin with PD ranged 2-4 mm. In conclusion, modification of the soft tissue thickness around the implant together with excellent plaque control by the patient successfully maintained peri-implant health.
种植体周围常见软硬组织缺损，这可能会影响种植体的存活。通常需要复杂的干预措施来处理和解决软硬组织缺损的组合问题。本病例报告描述了通过软组织改良来处理种植体周围软组织开窗并伴有与骨内缺损相关的骨裂开的情况。一名51岁女性因上颌左侧尖牙种植体支持冠唇侧软组织开窗被转诊至牙周病与口腔内科诊所。患者主诉种植体部位不适和有异味。种植体显示黏膜开窗，唇侧远中探诊深度（PD）为6mm，大量出血，种植体无松动。锥形束计算机断层扫描（CBCT）显示唇侧骨裂开，近中和远中面伴有5.56mm的骨内缺损。该种植体被诊断为伴有软组织缺损的种植体周围炎。治疗包括口腔卫生指导、种植体及所有天然牙的清创以及采用包膜技术的游离结缔组织移植的膜龈手术。清创术后两周，种植体的黏膜边缘消失，出现4×4mm的软组织裂开。3周后进行了膜龈手术。2年的随访显示黏膜边缘稳定，探诊深度在2 - 4mm之间。总之，种植体周围软组织厚度的改良以及患者出色的菌斑控制成功维持了种植体周围的健康。
