Prosthetic soft tissue management following two periimplant graft failures: a clinical report

A 53-year-old man experienced 2 soft tissue graft failures resulting in sizable hard and soft tissue defects in the esthetic zone following implant placement. A third connective tissue graft surgery was successful in repairing the defect and significantly improving soft tissue quality. A screw-retained, interim implant prosthesis was instrumental in gradually shaping the soft tissue over the course of the 3 surgeries. The interim prosthesis was modified numerous times to achieve a balance of esthetics, surgical protection, and gingival contours. The initial form of the prosthesis was designed to protect the surgical site and allow space for postsurgical edema. In its final form, the tissue side of the interim prosthesis pontic was designed to mimic the cross-sectional profile of a natural central incisor root but modified to deliver gentle pressure until maximum papilla height was achieved. The definitive restoration was fabricated to mimic the final design of the interim restoration and gingival architecture.