La gestion des tissus mous après les augmentations osseuses

Revue Réalités Cliniques / 25/09/2018
Résumé
Une restauration implantaire esthétique et fonctionnelle implique une bonne gestion des tissus durs et des tissus mous. Le type d’incision affecte la mobilité des tissus, la qualité de la vascularisation du lambeau et la position de la gencive marginale [1]. L’aspect esthétique avec le risque de formation de cicatrice joue également un rôle important. Une augmentation du volume osseux implique un lambeau approprié et la libération des tissus mous pour limiter le risque d’exposition [2]. L’inconvénient est le déplacement coronaire de la ligne muco-gingivale. Un manque de gencive fixe autour des implants peut compromettre l’intégration esthétique de la restauration mais aussi limiter le contrôle de plaque et entraîner la progression d’une péri-implantite [3]. Les incisions et sutures après les augmentations osseuses ont pour objectif de corriger et améliorer les tissus mous péri-mplantaires.

Abstract
Soft tissue management after bone augmentation
An aesthetic and functional implant restoration involves good management of hard tissues and soft tissues. The type of incision affects the mobility of the tissues, the quality of vascularisation of the flap and the position of the marginal gingivae [1]. Aesthetic appearance, with the risk of scar formation, also plays an important role. An increase in bone volume involves an appropriate flap and soft tissue release to limit the risk of exposure [2]. The disadvantage is the coronary displacement of the muco-gingival line. A lack of fixed gingiva around the implants can compromise the aesthetic integration of the restoration but also limit the control of plaque and lead to the progression of peri-implantitis [3]. The incisions and sutures after the bone increments are intended to correct and improve the peri-implant soft tissue.

Bibliographie

1. Zuhr O, Hürzeler M. Chirurgie plastique et esthétique en parodontie et implantologie : une approche microchirurgicale. Paris: Quintessence; 2013. 872 p.
2. De Stavola L, Tunkel J. The role played by a suspended external-internal suture in reducing marginal flap tension after bone reconstruction: a clinical prospective cohort study in the maxilla. Int J Oral Maxillofac Implants. 2014 Jul-Aug;29(4):921‑6.
3. Alpert A. A rationale for attached gingiva at the soft-tissue/implant interface: esthetic and functional dictates. Compend Newtown Pa. mars 1994;15(3):356, 358, 360‑362 passim; quiz 368.
4. Jung RE, Holderegger C, Sailer I, Khraisat A, Suter A, Hämmerle CHF. The effect of all-ceramic and porcelain-fused-to-metal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial. Int J Periodontics Restorative Dent. 2008 Aug;28(4):357‑65.
5. Gamborena I, Blatz MB. Évolution : protocoles actuels pour implants unitaires antérieurs. Paris : Quintessence; 2015. 440 p.
6. Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants. 2009;24 Suppl:218‑36.
7. Khoury F, Antoun H, Missika P. Bone augmentation in oral implantology. Paris: Quintessence; 2007, 448 p.
8. Khoury F. Greffe osseuse en implantologie. Paris: Quintessence; 2010, 520 p
9. Khoury F, Happe A. Soft tissue management in oral implantology: a review of surgical techniques for shaping an esthetic and functional peri-implant soft tissue structure. Quintessence Int. 2000 Jul-Aug;31(7):483‑99.
10. Gomez-Roman G. Influence of flap design on peri-implant interproximal crestal bone loss around single-tooth implants. Int J Oral Maxillofac Implants. 2001 Jan-Feb;16(1):61‑7.
11. Zucchelli G. Chirugie esthétique mucogingivale. Paris: Quintessence; 2014. 820 p.
12. Hirsch A, Attal U, Chai E, Goultschin J, Boyan BD, Schwartz Z. Root coverage and pocket reduction as combined surgical procedures. J Periodontol. 2001 Nov;72(11):1572‑9.
13. Jung U-W, Um Y-J, Choi S-H. Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J Periodontol. 2008 May;79(5):934‑40.
14. Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014 Apr;41 Suppl 15:S123-42.
15. Thoma DS, Buranawat B, Hämmerle CHF, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol. 2014 Apr;41 Suppl 15:S77-91.
16. Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol. 1996 Oct;23(10):971‑3.
17. Khoury F, Ponte A, Happe A. The 3D reconstruction of the alveolar crest with mandibular bone block graft: a clinical study. Int J Oral Maxillofac Implants. 2004;19:765.
18. Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res. 2016 Apr;27(4):491‑6.
19. Souza AB, Tormena M, Matarazzo F, Araújo MG. The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health. Clin Oral Implants Res. 2016 Jun;27(6):650‑5.
20. Nabers JM. Extension of the vestibular fornix utilizing a gingival graft: case history. Periodontics. 1966 Mar-Apr;4(2):77‑9.
21. Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968 Jun;6(3):121‑9.
22. Kazanjian V. Surgical operations as related to satisfactory dentures. Dent Cosmos. 1924;66:387‑95.
23. Fröschl T, Kerscher A. The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg. 1997 Apr;25(2):85‑90.
24. Kwakman JM, Voorsmit RA, Freihofer HP. Treatment of the edentulous mandible with a vestibuloplasty combined with Intramobil Zylinder implants: a 5-year follow-up. Br J Oral Maxillofac Surg. 1998 Aug;36(4):296‑300.
25. Khoury F. Die modifizierte Alveolar - Extensionplastik. Z. Zahn-ärztl Implantol. 1987;3:174‑8.
26. Ponte A, Khoury F. The tunnel technique in bone grafting procedures: a clinical study (abstract). Int J Oral Maxillofac Implants. 2004;19:766.
27. Nabers CL. Repositioning the attached gingiva. J Periodontol. 1954 Jan;25(1):38‑9.
28. Vence MG. Vestibular transposed palatal flap (VTPF) in implantology. Clin Odontol. 1990 Oct;11(5):321‑6.
29. Palacci P, Ericsson I, Engstrand P, Rongert B. Optimal implant positioning & soft tissue management for the Branemark system. Chicago: Quintessence. 1995, 84 p.
30. Adriaenssens P, Hermans M, Ingber A, Prestipino V, Daelemans P, Malevez C. Palatal sliding strip flap: soft tissue management to restore maxillary anterior esthetics at stage 2 surgery: a clinical report. Int J Oral Maxillofac Implants. 1999 Jan-Feb;14(1):30‑6.
31. Jemt T. Regeneration of gingival papillae after single-implant treatment. Int J Periodontics Restorative Dent. 1997 Aug;17(4):326‑33.
32. Fagan F, Freeman E. Clinical comparison of the free gingival graft and partial thickness apically positioned flap. J Periodontol. 1974 Jan;45(1):3‑8.
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