Complications and treatment errors in peri-implant soft tissue management.

Inadequate quality, quantity, or aesthetics of the peri-implant soft tissues can result from a combination of factors related to the outcome of treatments performed before, during, or after implant placement. In this paper, we describe in detail the treatment errors that can pave the way for the onset of mucositis or give rise to soft tissue complications such as peri-implant soft tissue discoloration or dehiscence, graft exposure, or scar formation. By tracing the error back to the planning or surgical stage, clinical insights on surgical soft tissue management are provided to avoid or treat complications that affect the status of the peri-implant soft tissues. Mastering the learning curve and knowing the limitations of each technique are fundamental for preventing added treatment failures that can result in increased patient morbidity and overall discontent.

Avoiding errors and complications related to immediate implant placement in the esthetic area with a mucogingival approach.

Immediate implant placement is considered the treatment of choice for single tooth replacement in the esthetic area. However, this treatment is associated with several critical drawbacks related to the inadequate assessment/management of the soft and hard peri-implant tissues and their subsequent remodeling, resulting in peri-implant soft-tissue defects that can lead to impaired esthetic outcomes in time. We describe in detail how the mucogingival approach to immediate implant placement ensures a standard result regardless of the baseline soft-hard tissue situation. Fully guided implant placement guarantees an adequate three-dimensional implant placement, the flap design makes it possible to perform bone augmentation with complete visibility of the area being treated, allows soft tissue augmentation with proper fixation of the connective tissue graft, and the placement of an immediate provisional ensures stabilization of the peri-implant tissues throughout the healing period.

Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors.

Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.

Complications and treatment errors in root coverage procedures.

Root coverage procedures have become very common in clinical dental practice. Even though these techniques are considered safe, the clinician may face several issues during the therapy due to their surgical nature. Some of these issues can be defined strictly as complications inherent to the procedure, whereas others are medical errors or treatment errors. This review will focus on describing treatment errors and complications that may arise during different phases of the root coverage therapeutic process and on how to prevent and manage them.

Patient-reported outcome measures after periodontal surgery.

OBJECTIVES: The present study aimed to explore the impact of different periodontal surgical treatments on the quality of life and postoperative morbidity. MATERIALS AND METHODS: The present study is a single-center, prospective, observational cohort trial. One hundred fifty-five patients, referred to the Periodontal Department of Bologna University who needed periodontal surgical treatment, were recruited. The self-reported perception of the postoperative course was assessed using the following anonymous questionnaires: Italian oral health impact profile (I-OHIP-14), visual analog scale (VAS) to evaluate the intensity of the pain, and 5-point Likert scale. RESULTS: Patients reported a mean OHIP-14 total score of 9.87±8.5 (range 0-42), significantly influenced by the female sex, flap extension, and periodontal dressing. A mean VAS score of 2.96±2.39 (range 0-9) was calculated, and was found to be influenced by the presence of vertical releasing incisions and palatal flap extension. Of the 155 subjects, 40 (25.8%) patients reported bleeding as a post-surgical complication, 96 (61.9%) swelling, 105 (67.7%) eating discomfort, and 44 (28.4%) reported speech discomfort. CONCLUSIONS: Within the limitations of the nature of the present study, periodontal surgical procedures have a low impact on patients' quality of life evaluated through the OHIP-14 and VAS pain questionnaires. CLINICAL RELEVANCE: Periodontal surgical procedures are safe procedures, with a limited duration of postoperative discomfort as well as the incidence of complications.

Treatment of Deep Isolated Gingival Recession Defects Affecting Mandibular Incisors: A Novel Interdisciplinary Orthodontic-Mucogingival Approach.

Tooth malposition negatively affects the outcome of root coverage procedures, limiting chances for complete root coverage (CRC). This case series introduces a combined orthodontic-mucogingival approach for the treatment of deep (> 4 mm) isolated gingival recession defects affecting mandibular incisors with a buccally displaced root. Twenty patients were treated with a novel orthodontic device (FZ Root Torque Controller) for selective correction of tooth malposition at the affected site, turning all isolated recessions into Miller Classes I and II. Subsequent surgical treatment of the gingival recession with a vertically-coronally advanced flap plus a connective tissue graft achieved 90% CRC at the 1-year follow-up, with a recession reduction of 5.6 ± 1.5 mm, a 1.24 ± 0.24 mm increase in gingival thickness, and improved esthetic outcomes.

Porcine-Derived Acellular Dermal Matrix for Buccal Soft Tissue Augmentation at Single Implant Sites: A 1-Year Follow-up Case Series.

Soft tissue augmentation procedures are crucial to obtain a successful outcome in implant therapy. The aim of this case series was to describe the 1-year clinical outcomes of a porcine-derived acellular dermal matrix for buccal mucosal thickness augmentation at osseointegrated single implants with facial peri-implant soft tissue deficiencies. Ten patients were included and treated with a prosthetic and surgical approach that combined a coronally advanced flap and a dermal matrix. Results showed the possibility to obtain an increase in buccal soft tissue thickness of 1.2 ± 0.18 mm at single implant sites in the esthetic area.