A simplified soft tissue management for peri-implant bone augmentation

This case series illustrates a simplified soft tissue management, namely, the subperiosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant.

Twenty-seven implants in 16 patients presenting either a buccal bone dehiscence or a thin (< 1 mm) buccal cortical bone plate (BCBP) were consecutively treated. Briefly, a split-thickness flap (namely, the mucosal layer) was raised on the buccal aspect. Then, the periosteal layer was elevated from the bone crest. A full-thickness flap was elevated on the oral aspect. After implant site preparation, a xenograft was used to fill the space between the periosteal layer and the BCBP and/or exposed implant surface and, if present, to completely correct the bone dehiscence. The periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At 3 to 6 months, a re-entry procedure for implant exposure was performed.

Healing was uneventful, with no signs of infection in all cases. A wound dehiscence was observed in three implants in two patients at 2 weeks postsurgery. Out of 15 implants showing an initial bone dehiscence, 12 implants (80%) showed a complete resolution, with a subperiosteal tissue thickness (SPTT) at the time of re-entry of 3.1 ± 1.0 mm. Three implants presented a residual dehiscence of 1 mm (two implants) or 2 mm (one implant), with a SPTT of at least 2 mm. Out of 12 implants showing a thin BCBP at implant placement, 10 implants (90%) revealed a SPTT ≥ 2 at the time of re-entry. Two implants revealed a SPTT of 1 mm.

The SPAL technique represents a valuable simplified surgical approach associated with a low rate of complications in the treatment of peri-implant bone dehiscence and in the horizontal augmentation of peri-implant tissue thickness.