Peri-implant Papillae Reconstruction at an Esthetically Failing Implant

This case report aimed to describe a soft tissue approach to restore a buccal soft tissue dehiscence (BSTD) combined with the loss of peri-implant papillae and loss of periodontal attachment on the adjacent teeth. The first step of the proposed approach was the removal of the crown and abutment to leave the interproximal soft tissue to fill the space previously occupied by the crown. After 3 months, during which time the patient was wearing a provisional restoration (a temporary Maryland bridge), the implant site was treated as an edentulous area with a soft tissue augmentation procedure: the most substantial modification with respect to the original connective tissue platform technique was the use of the wide mesial and distal papillae of the implant, once de-epithelialized on the occlusal surface, as a "partial" connective platform to suture the connective grafts and submerge the implant. At the 4-month reevaluation visit, a minor soft tissue defect remained in both apico-coronal and buccolingual dimensions, and thus a second surgery was performed to obtain further soft tissue augmentation. A flapless punch procedure was used to expose the implant head, and after conditioning the augmented peri-implant soft tissue with a new provisional crown, the definitive restoration was delivered. Complete coverage of the BSTD was achieved, and both papillae entirely filled the interproximal spaces. The results were well maintained up to the 5-year follow-up visit.