Skip to main content
SpringerLink
Log in

Microscope-Assisted Implant Complication Management

  • Chapter
  • First Online:
Microsurgery in Periodontal and Implant Dentistry

  • 671 Accesses

Abstract

Accidents and complications are unavoidable from time to time when placing implants, but the surgeon should know how to prevent and treat those complications. The use of microscope, its illumination, and magnification allow the practitioner to increase the predictability of treatment, allowing better precision in managing the tissues. In some narrow and deep spaces, the use of the OM as its coaxial light facilitates a sharp field of view. The surgeon’s abilities and predictability of surgical techniques increase, employing minimally invasive surgeries and solving several problems reducing treatment time, costs, and morbidity for the patient at the same time. This kind of dentistry becomes more gratifying and motivating for the practitioner and the whole team, reducing the patient’s anxiety level.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Annibali S, La Monaca G, Tantardini M, Cristalli MP. The role of the template in prosthetically guided implantology. J Prosthodont. 2009;18:177–83.

    Article  PubMed  Google Scholar 

  2. Hanif A, Qureshi S, Sheikh Z, Rashid H. Complications in implant dentistry. Eur J Dent. 2017;11:135–40.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dreiseidler T, Mischkowski RA, Neugebauer J, Ritter L, Zöller JE. Comparison of cone-beam imaging with orthopantomography and computerized tomography for assessment in presurgical implant dentistry. Int J Oral Maxillofac Implants. 2009;24:216–25.

    PubMed  Google Scholar 

  4. Ozcelik O, Haytac MC, Akkaya M. Iatrogenic trauma to oral tissues. J Periodontol. 2005;76:1793–7.

    Article  PubMed  Google Scholar 

  5. Zhou W, Han C, Li D, Li Y, Song Y, Zhao Y. Endodontic treatment of teeth induces retrograde peri-implantitis. Clin Oral Implants Res. 2009;20:1326–32.

    Article  PubMed  Google Scholar 

  6. Mardinger O, Manor Y, Mijiritsky E, Hirshberg A. Lingual perimandibular vessels associated with life-threatening bleeding: an anatomic study. Int J Oral Maxillofac Implants. 2007;22:127–31.

    PubMed  Google Scholar 

  7. Hur Y, Tsukiyama T, Yoon TH, Griffin T. Double flap incision design for guided bone regeneration: a novel technique and clinical considerations. J Periodontol. 2010;81:945–52.

    Article  PubMed  Google Scholar 

  8. Neugebauer J, Scheer M, Mischkowski RA, An SH, Karapetian VE, Toutenburg H, Zoeller JE. Comparison of torque measurements and clinical handling of various surgical motors. Int J Oral Maxillofac Implants. 2009;24:469–76.

    PubMed  Google Scholar 

  9. Garfunkel AA, Galili D, Findler M, Lubliner J, Eldor A. Bleeding tendency: a practical approach in dentistry. Compend Contin Educ Dent. 1999;20(836–8):840–2. 844 passim.

    Google Scholar 

  10. Kang K, Grover D, Goel V, Kaushal S, Kaur G. Periodontal microsurgery and microsurgical instrumentation: a review. Dent J Adv Stud. 2016;4:74–80.

    Article  Google Scholar 

  11. Belcher JM. A perspective on periodontal microsurgery. Int J Periodontics Restorative Dent. 2001;21:191–6.

    PubMed  Google Scholar 

  12. Steigmann M. Aesthetic flap design for correction of buccal fenestration defects. Pract Proced Aesthet Dent. 2008;20:487–93. Quiz 494.

    PubMed  Google Scholar 

  13. Braut V, Bornstein MM, Belser U, Buser D. Thickness of the anterior maxillary facial bone wall-a retrospective radiographic study using cone beam computed tomography. Int J Periodontics Restorative Dent. 2011;31:125–31.

    PubMed  Google Scholar 

  14. Chiapasco M, Zaniboni M. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res. 2009;20:113–23.

    Article  PubMed  Google Scholar 

  15. Jung RE, Hälg GA, Thoma DS, Hämmerle CH. A randomized, controlled clinical trial to evaluate a new membrane for guided bone regeneration around dental implants. Clin Oral Implants Res. 2009;20:162–8.

    Article  PubMed  Google Scholar 

  16. MacDonald JD. Learning to perform microvascular anastomosis. Skull Base. 2005;15:229–40.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Derman GH, Schenck RR. Microsurgical technique—fundamentals of the microsurgical laboratory. Orthop Clin North Am. 1977;8:229–48.

    Article  PubMed  Google Scholar 

  18. Misch CE, Resnik R. Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol. Implant Dent. 2010;19:378–86.

    Article  PubMed  Google Scholar 

  19. Cannizzaro G, Leone M, Esposito M. Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla: 1-year follow-up of a single cohort study. Int J Oral Maxillofac Implants. 2007;22:87–95.

    PubMed  Google Scholar 

  20. Cannizzaro G, Leone M, Consolo U, Ferri V, Esposito M. Immediate functional loading of implants placed with flapless surgery versus conventional implants in partially edentulous patients: a 3-year randomized controlled clinical trial. Int J Oral Maxillofac Implants. 2008;23:867–75.

    PubMed  Google Scholar 

  21. Merli M, Bernardelli F, Esposito M. Computer-guided flapless placement of immediately loaded dental implants in the edentulous maxilla: a pilot prospective case series. Eur J Oral Implantol. 2008;1:61–9.

    PubMed  Google Scholar 

  22. Arisan V, Karabuda CZ, Ozdemir T. Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res. 2010;21:980–8.

    Article  PubMed  Google Scholar 

  23. Elian N, Cho SC, Froum S, Smith RB, Tarnow DP. A simplified socket classification and repair technique. Pract Proced Aesthet Dent. 2007;19:99–104.

    PubMed  Google Scholar 

  24. da Rosa JC, Rosa AC, da Rosa DM, Zardo CM. Immediate Dentoalveolar Restoration of compromised sockets: a novel technique. Eur J Esthet Dent. 2013;8:432–43.

    PubMed  Google Scholar 

  25. Zufía J, Blasi G, Gómez-Meda R, Blasi A. The four-layer graft technique, a hard and soft tissue graft from the tuberosity in one piece. J Esthet Restor Dent. 2019;31:304–10.

    Article  PubMed  Google Scholar 

  26. Lee S, Thiele C. Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J Oral Maxillofac Surg. 2010;68:2169–78.

    Article  PubMed  Google Scholar 

  27. Watzak G, Tepper G, Zechner W, Monov G, Busenlechner D, Watzek G. Bony press-fit closure of oro-antral fistulas: a technique for pre-sinus lift repair and secondary closure. J Oral Maxillofac Surg. 2005;63:1288–94.

    Article  PubMed  Google Scholar 

  28. Burkhardt R, Lang NP. Role of flap tension in primary wound closure of mucoperiosteal flaps: a prospective cohort study. Clin Oral Implants Res. 2010;21:50–4.

    Article  PubMed  Google Scholar 

  29. Mörmann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol. 1977;48:681–92.

    Article  PubMed  Google Scholar 

  30. Zuhr O, Rebele SF, Cheung SL, Hürzeler MB. Research Group on Oral Soft Tissue Biology and Wound Healing. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000. 2018;77:123–49.

    Article  PubMed  Google Scholar 

  31. Salvi GE, Brägger U. Mechanical and technical risks in implant therapy. Int J Oral Maxillofac Implants. 2009;24:69–85.

    PubMed  Google Scholar 

  32. Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res. 2012;23:2–21.

    Article  PubMed  Google Scholar 

  33. Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral Implants Res. 2007;18:97–113.

    Article  PubMed  Google Scholar 

  34. Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent. 1999;81:537–52.

    Article  PubMed  Google Scholar 

  35. Eckert SE, Meraw SJ, Cal E, Ow RK. Analysis of incidence and associated factors with fractured implants: a retrospective study. Int J Oral Maxillofac Implants. 2000;15:662–7.

    PubMed  Google Scholar 

  36. Kohal RJ, Wolkewitz M, Mueller C. Alumina-reinforced zirconia implants: survival rate and fracture strength in a masticatory simulation trial. Clin Oral Implants Res. 2010;21:1345–52.

    Article  PubMed  Google Scholar 

  37. Al Quran FA, Rashan BA, Al-Dwairi ZN. Management of dental implant fractures. A case history. J Oral Implantol. 2009;35:210–4.

    Article  PubMed  Google Scholar 

  38. Al Jabbari YS, Fournelle R, Ziebert G, Toth J, Iacopino AM. Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 4: failure analysis of 10 fractured retaining screws retrieved from three patients. J Prosthodont. 2008;17:201–10.

    Article  PubMed  Google Scholar 

  39. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol. 2002;29:197–212. Discussion 232–3.

    Article  PubMed  Google Scholar 

  40. Lindhe J, Meyle J, Group D of European Workshop on Periodontology. Peri-implant diseases: consensus report of the sixth European workshop on periodontology. J Clin Periodontol. 2008;35:282–5.

    Article  PubMed  Google Scholar 

  41. Dreyer H, Grischke J, Tiede C, Eberhard J, Schweitzer A, Toikkanen SE, Glöckner S, Krause G, Stiesch M. Epidemiology and risk factors of peri-implantitis: a systematic review. J Periodontal Res. 2018;53:657–81.

    Article  PubMed  Google Scholar 

  42. Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80:1388–92.

    Article  PubMed  Google Scholar 

  43. Froum SJ, Froum SH, Rosen PS. A regenerative approach to the successful treatment of peri-implantitis: a consecutive series of 170 implants in 100 patients with 2- to 10-year follow-up. Int J Periodontics Restorative Dent. 2015;35:857–63.

    Article  PubMed  Google Scholar 

  44. Persson GR, Samuelsson E, Lindahl C, Renvert S. Mechanical non-surgical treatment of peri-implantitis: a single-blinded randomized longitudinal clinical study. II. Microbiological results. J Clin Periodontol. 2010;37:563–73.

    Article  PubMed  Google Scholar 

  45. Mombelli A, Lang NP. Antimicrobial treatment of peri-implant infections. Clin Oral Implants Res. 1992;3:162–8.

    Article  PubMed  Google Scholar 

  46. Deppe H, Horch HH, Henke J, Donath K. Peri-implant care of ailing implants with the carbon dioxide laser. Int J Oral Maxillofac Implants. 2001;16:659–67.

    PubMed  Google Scholar 

  47. Subramani K, Wismeijer D. Decontamination of titanium implant surface and re-osseointegration to treat peri-implantitis: a literature review. Int J Oral Maxillofac Implants. 2012;27:1043–54.

    PubMed  Google Scholar 

  48. Romeo E, Ghisolfi M, Murgolo N, Chiapasco M, Lops D, Vogel G. Therapy of peri-implantitis with resective surgery. A 3-year clinical trial on rough screw-shaped oral implants. Part I: clinical outcome. Clin Oral Implants Res. 2005;16:9–18.

    Article  PubMed  Google Scholar 

  49. Serino G, Turri A. Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans. Clin Oral Implants Res. 2011;22:1214–20.

    Article  PubMed  Google Scholar 

  50. Renvert S, Polyzois I, Claffey N. Surgical therapy for the control of peri-implantitis. Clin Oral Implants Res. 2012;23:84–94.

    Article  PubMed  Google Scholar 

  51. Hsu YT, Mason SA, Wang HL. Biological implant complications and their management. J Int Acad Periodontol. 2014;16:9–18.

    PubMed  Google Scholar 

  52. Bengazi F, Wennström JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res. 1996;7:303–10.

    Article  PubMed  Google Scholar 

  53. Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol. 2003;8:303–20.

    Article  PubMed  Google Scholar 

  54. Shibli JA, d’Avila S, Marcantonio E Jr. Connective tissue graft to correct peri-implant soft tissue margin: a clinical report. J Prosthet Dent. 2004;91:119–22.

    Article  PubMed  Google Scholar 

  55. Burkhardt R, Joss A, Lang NP. Soft tissue dehiscence coverage around endosseous implants: a prospective cohort study. Clin Oral Implants Res. 2008;19:451–7.

    Article  PubMed  Google Scholar 

  56. Frost NA, Mealey BL, Jones AA, Huynh-Ba G. Periodontal biotype: gingival thickness as it relates to probe visibility and buccal plate thickness. J Periodontol. 2015;86:1141–9.

    Article  PubMed  Google Scholar 

  57. Cosgarea R, Gasparik C, Dudea D, Culic B, Dannewitz B, Sculean A. Peri-implant soft tissue colour around titanium and zirconia abutments: a prospective randomized controlled clinical study. Clin Oral Implants Res. 2015;26:537–44.

    Article  PubMed  Google Scholar 

  58. Wessels R, De Roose S, De Bruyckere T, Eghbali A, Jacquet W, De Rouck T, et al. The mucosal scarring index: reliability of a new composite index for assessing scarring following oral surgery. Clin Oral Investig. 2019;23:1209–15.

    Article  PubMed  Google Scholar 

  59. Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16:639–44.

    Article  PubMed  Google Scholar 

  60. Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D. Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores. J Periodontol. 2009;80:140–51.

    Article  PubMed  Google Scholar 

  61. D’haese J, Ackhurst J, Wismeijer D, De Bruyn H, Tahmaseb A. Current state of the art of computer-guided implant surgery. Periodontol 2000. 2017;73:121–33.

    Article  PubMed  Google Scholar 

  62. Esquivel J, Meda RG, Blatz MB. The impact of 3D implant position on emergence profile design. Int J Periodontics Restorative Dent. 2021;41:79–86.

    Article  PubMed  Google Scholar 

  63. Kan JY, Rungcharassaeng K, Lozada JL, Zimmerman G. Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year follow-up. Int J Oral Maxillofac Implants. 2011;26:179–87.

    PubMed  Google Scholar 

  64. Roccuzzo M, Gaudioso L, Bunino M, Dalmasso P. Surgical treatment of buccal soft tissue recessions around single implants: 1-year results from a prospective pilot study. Clin Oral Implants Res. 2014;25:641–6.

    Article  PubMed  Google Scholar 

  65. Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M, Montebugnoli L. A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res. 2013;24:957–62.

    PubMed  Google Scholar 

  66. Anderson LE, Inglehart MR, El-Kholy K, Eber R, Wang HL. Implant associated soft tissue defects in the anterior maxilla: a randomized control trial comparing subepithelial connective tissue graft and acellular dermal matrix allograft. Implant Dent. 2014;23:416–25.

    PubMed  Google Scholar 

  67. Frizzera F, de Freitas RM, Muñoz-Chávez OF, Cabral G, Shibli JA, Marcantonio E Jr. Impact of soft tissue grafts to reduce peri-implant alterations after immediate implant placement and provisionalization in compromised sockets. Int J Periodontics Restorative Dent. 2019;39:381–9.

    Article  PubMed  Google Scholar 

  68. Rompen E, Raepsaet N, Domken O, Touati B, Van Dooren E. Soft tissue stability at the facial aspect of gingivally converging abutments in the esthetic zone: a pilot clinical study. J Prosthet Dent. 2007;97:S119–25.

    Article  PubMed  Google Scholar 

  69. Gomez-Meda R, Esquivel J, Blatz MB. The esthetic biological contour concept for implant restoration emergence profile design. J Esthet Restor Dent. 2021;33:173–84.

    Article  PubMed  Google Scholar 

  70. Zucchelli G, Mazzotti C, Mounssif I, Marzadori M, Stefanini M. Esthetic treatment of peri-implant soft tissue defects: a case report of a modified surgical-prosthetic approach. Int J Periodontics Restorative Dent. 2013;33:327–35.

    Article  PubMed  Google Scholar 

  71. Zucchelli G, Felice P, Mazzotti C, Marzadori M, Mounssif I, Monaco C, et al. 5-year outcomes after coverage of soft tissue dehiscence around single implants: a prospective cohort study. Eur J Oral Implantol. 2018;11:215–24.

    PubMed  Google Scholar 

  72. Katafuchi M, Weinstein BF, Leroux BG, Chen YW, Daubert DM. Restoration contour is a risk indicator for peri-implantitis: a cross-sectional radiographic analysis. J Clin Periodontol. 2018;45:225–32.

    Article  PubMed  Google Scholar 

  73. Wennström JL. Mucogingival considerations in orthodontic treatment. Semin Orthod. 1996;2:46–54.

    Article  PubMed  Google Scholar 

  74. Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent. 2007;27:251–7.

    PubMed  Google Scholar 

  75. Speroni S, Cicciu M, Maridati P, Grossi GB, Maiorana C. Clinical investigation of mucosal thickness stability after soft tissue grafting around implants: a 3-year retrospective study. Indian J Dent Res. 2010;21:474–9.

    Article  PubMed  Google Scholar 

  76. Stimmelmayr M, Allen EP, Reichert TE, Iglhaut G. Use of a combination epithelized-subepithelial connective tissue graft for closure and soft tissue augmentation of an extraction site following ridge preservation or implant placement: description of a technique. Int J Periodontics Restorative Dent. 2010;30:375–81.

    PubMed  Google Scholar 

  77. 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;41:S123–42.

    Article  PubMed  Google Scholar 

  78. Wennström JL. Lack of association between width of attached gingiva and development of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol. 1987;14:181–4.

    Article  PubMed  Google Scholar 

  79. Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol. 2013;84:1755–67.

    Article  PubMed  Google Scholar 

  80. Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89:S313–8.

    Article  PubMed  Google Scholar 

  81. Isler SC, Uraz A, Kaymaz O, Cetiner D. An evaluation of the relationship between peri-implant soft tissue biotype and the severity of peri-implantitis: a cross-sectional study. Int J Oral Maxillofac Implants. 2019;34:187–96.

    Article  PubMed  Google Scholar 

  82. Cordaro L, Torsello F, Roccuzzo M. Clinical outcome of submerged vs. non-submerged implants placed in fresh extraction sockets. Clin Oral Implants Res. 2009;20:1307–13.

    Article  PubMed  Google Scholar 

  83. Cooper LF, Reside G, Stanford C, Barwacz C, Feine J, Nader SA, et al. Three-year prospective randomized comparative assessment of anterior maxillary single implants with different abutment interfaces. Int J Oral Maxillofac Implants. 2019;34:150–8.

    Article  PubMed  Google Scholar 

  84. Ryser MR, Block MS, Mercante DE. Correlation of papilla to crestal bone levels around single tooth implants in immediate or delayed crown protocols. J Oral Maxillofac Surg. 2005;63:1184–95.

    Article  PubMed  Google Scholar 

  85. Froum SJ, Khouly I. Survival rates and bone and soft tissue level changes around one-piece dental implants placed with a flapless or flap protocol: 8.5-year results. Int J Periodontics Restorative Dent. 2017;37:327–37.

    Article  PubMed  Google Scholar 

  86. Sukekava F, Pannuti CM, Lima LA, Tormena M, Araújo MG. Dynamics of soft tissue healing at implants and teeth: a study in a dog model. Clin Oral Implants Res. 2016;27:545–52.

    Article  PubMed  Google Scholar 

  87. Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B, Thomsen P. The soft tissue barrier at implants and teeth. Clin Oral Implants Res. 1991;2:81–90.

    Article  PubMed  Google Scholar 

  88. Hidaka T, Ueno D. Mucosal dehiscence coverage for dental implant using split pouch technique: a two-stage approach [corrected]. J Periodontal Implant Sci. 2012;42(3):105–9. https://doi.org/10.5051/jpis.2012.42.3.105. Erratum in: J Periodontal Implant Sci. 2012;42:146.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Lai YL, Chen HL, Chang LY, Lee SY. Resubmergence technique for the management of soft tissue recession around an implant: case report. Int J Oral Maxillofac Implants. 2010;25:201–4.

    PubMed  Google Scholar 

  90. Kleinheinz J, Büchter A, Kruse-Lösler B, Weingart D, Joos U. Incision design in implant dentistry based on vascularization of the mucosa. Clin Oral Implants Res. 2005;16:518–23.

    Article  PubMed  Google Scholar 

  91. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent. 1994;14:216–27.

    PubMed  Google Scholar 

  92. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent. 1999;19:199–206.

    PubMed  Google Scholar 

  93. Girbés-Ballester P, Viña-Almunia J, Peñarrocha-Oltra D, Peñarrocha-Diago M. Soft tissue response in posterior teeth adjacent to interdental single implants: a controlled randomized clinical trial comparing intrasulcular vs trapezoidal incision. Int J Oral Maxillofac Implants. 2016;31:631–41.

    Article  PubMed  Google Scholar 

  94. Mareque-Bueno S. A novel surgical procedure for coronally repositioning of the buccal implant mucosa using acellular dermal matrix: a case report. J Periodontol. 2011;82:151–6.

    Article  PubMed  Google Scholar 

  95. Sculean A, Mihatovic I, Shirakata Y, Bosshardt DD, Schwarz F, Iglhaut G. Healing of localized gingival recessions treated with coronally advanced flap alone or combined with either a resorbable collagen matrix or subepithelial connective tissue graft. A preclinical study. Clin Oral Investig. 2015;19:903–9.

    Article  PubMed  Google Scholar 

  96. Thoma DS, Naenni N, Figuero E, Hämmerle CH, Schwarz F, Jung RE, et al. Effects of soft tissue augmentation procedures on peri-implant health or disease: a systematic review and meta-analysis. Clin Oral Implants Res. 2018;29:32–49.

    Article  PubMed  Google Scholar 

  97. Rojo E, Stroppa G, Sanz-Martin I, Gonzalez-Martín O, Alemany AS, Nart J. Soft tissue volume gain around dental implants using autogenous subepithelial connective tissue grafts harvested from the lateral palate or tuberosity area. A randomized controlled clinical study. J Clin Periodontol. 2018;45:495–503.

    Article  PubMed  Google Scholar 

  98. Amin PN, Bissada NF, Ricchetti PA, Silva AP, Demko CA. Tuberosity versus palatal donor sites for soft tissue grafting: a split-mouth clinical study. Quintessence Int. 2018;49:589–98.

    PubMed  Google Scholar 

  99. Jemt T. Regeneration of gingival papillae after single-implant treatment. Int J Periodontics Restorative Dent. 1997;17:326–33.

    PubMed  Google Scholar 

  100. Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, et al. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol. 2003;74:1785–8.

    Article  PubMed  Google Scholar 

  101. Salama H, Salama MA, Garber D, Adar P. The interproximal height of bone: a guidepost to predictable aesthetic strategies and soft tissue contours in anterior tooth replacement. Pract Periodontics Aesthet Dent. 1998;10:1131–41.

    PubMed  Google Scholar 

  102. Nemcovsky CE, Moses O, Artzi Z. Interproximal papillae reconstruction in maxillary implants. J Periodontol. 2000;71:308–14.

    Article  PubMed  Google Scholar 

  103. Urban IA, Klokkevold PR, Takei HH. Abutment-supported papilla: a combined surgical and prosthetic approach to papilla reformation. Int J Periodontics Restorative Dent. 2016;36:665–71.

    Article  PubMed  Google Scholar 

  104. Cirelli JA, Cirelli CC, Holzhausen M, Martins LP, Brandão CH. Combined periodontal, orthodontic, and restorative treatment of pathologic migration of anterior teeth: a case report. Int J Periodontics Restorative Dent. 2006;26:501–6.

    PubMed  Google Scholar 

  105. Wittneben JG, Buser D, Belser UC, Brägger U. Peri-implant soft tissue conditioning with provisional restorations in the esthetic zone: the dynamic compression technique. Int J Periodontics Restorative Dent. 2013;33:447–55.

    Article  PubMed  Google Scholar 

  106. Feuillet D, Keller JF, Agossa K. Interproximal tunneling with a customized connective tissue graft: a microsurgical technique for interdental papilla reconstruction. Int J Periodontics Restorative Dent. 2018;38:833–9.

    Article  PubMed  Google Scholar 

  107. Geurs NC, Romanos AH, Vassilopoulos PJ, Reddy MS. Efficacy of micronized acellular dermal graft for use in interproximal papillae regeneration. Int J Periodontics Restorative Dent. 2012;32:49–58.

    PubMed  Google Scholar 

  108. Awartani FA, Tatakis DN. Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series. Clin Oral Investig. 2016;20:1775–80.

    Article  PubMed  Google Scholar 

  109. Bertl K, Gotfredsen K, Jensen SS, Bruckmann C, Stavropoulos A. Can hyaluronan injections augment deficient papillae at implant-supported crowns in the anterior maxilla? A randomized controlled clinical trial with 6 months follow-up. Clin Oral Implants Res. 2017;28:1054–61.

    Article  PubMed  Google Scholar 

  110. Korayem M, Flores-Mir C, Nassar U, Olfert K. Implant site development by orthodontic extrusion. A systematic review. Angle Orthod. 2008;78:752–60.

    Article  PubMed  Google Scholar 

  111. Buskin R, Castellon P, Hochstedler JL. Orthodontic extrusion and orthodontic extraction in preprosthetic treatment using implant therapy. Pract Periodontics Aesthet Dent. 2000;12:213–9.

    PubMed  Google Scholar 

  112. Viana PC, Kovacs Z, Correia A. Purpose of esthetic risk assessment in prosthetic rehabilitations with gingiva-shade ceramics. Int J Esthet Dent. 2014;9:480–9.

    PubMed  Google Scholar 

  113. Burkhardt R, Hämmerle CHF, Lang NP, Research Group on Oral Soft Tissue Biology & Wound Healing. How do visual-spatial and psychomotor abilities influence clinical performance in periodontal plastic surgery? J Clin Periodontol. 2019;46:72–85.

    Article  PubMed  Google Scholar 

  114. Wetzel CM, Black SA, Hanna GB, Athanasiou T, Kneebone RL, Nestel D, Wolfe JH, Woloshynowych M. The effects of stress and coping on surgical performance during simulations. Ann Surg. 2010;251:171–6.

    Article  PubMed  Google Scholar 

  115. Renouard F, Amalberti R, Renouard E. Are “human factors” the primary cause of complications in the field of implant dentistry? Int J Oral Maxillofac Implants. 2017;32:e55–61.

    Article  PubMed  Google Scholar 

  116. Barone A, Toti P, Marconcini S, Derchi G, Saverio M, Covani U. Esthetic outcome of implants placed in fresh extraction sockets by clinicians with or without experience: a medium-term retrospective evaluation. Int J Oral Maxillofac Implants. 2016;31:1397–406.

    Article  PubMed  Google Scholar 

  117. Shanelec DA, Tibbetts LS. A perspective on the future of periodontal microsurgery. Periodontol 2000. 1996;11:58–64.

    Article  PubMed  Google Scholar 

  118. Tibbetts LS, Shanelec D. Periodontal microsurgery. Dent Clin N Am. 1998;42:339–59.

    Article  PubMed  Google Scholar 

  119. Nordland WP, Sandhu HS, Perio C. Microsurgical technique for augmentation of the interdental papilla: three case reports. Int J Periodontics Restorative Dent. 2008;28:543–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Prosthodontics, LSUHSC School of Dentistry, New Orleans, LA, USA

    Ramon Gomez-Meda & Jonathan Esquivel

Authors
  1. Ramon Gomez-Meda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan Esquivel
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. School of Dentistry, University of Michigan, Ann Arbor, MI, USA

    Hsun-Liang (Albert) Chan

  2. School of Dentistry, University of Michigan, Ann Abor, MI, USA

    Diego Velasquez-Plata

1 Electronic Supplementary Material

The periosteum is cut and the dental nerve isolated with precision (MP4 12,081 kb)

The video shows how to locate the greater palatine artery to avoid its damage (MP4 14,136 kb)

Lateralization of the dental nerve avoiding its damage in order to place implants in the posterior area of an atrophic mandible (MP4 16,082 kb)

Papilla elevation should be done with care to keep the integrity of the flap (MP4 19,658 kb)

After placing an immediate implant, integrity of the cortical bone plates is easily checked out with the help of the microscope (MP4 15,596 kb)

Tunneling techniques without applying too much tension on the tissues are primordial in complex cases to allow the revascularization of the connective tissue graft (MP4 30,155 kb)

Microsutures avoid tension in the margin of the flap avoiding necrosis and improving the healing process (MP4 71,757 kb)

Damaged screws can be easily retrieved with the help of magnification (MP4 30,593 kb)

Minimally invasive techniques can be applied even in complex cases with proper magnification and illumination (MP4 31,250 kb)

Retrieving screws with a proper illumination and magnification can avoid any damage to the implant or abutments (MP4 27,778 kb)

Complex cases may require raising a flap to preserve the maximum quantity of bone when retrieving an implant with a trephine (MP4 46,198 kb)

Broken screws may force the clinician to use a trephine to retrieve the implant (MP4 59,033 kb)

Polishing and shining of the implant head may be a clinical option in those implants with a mild bone loss (MP4 33,333 kb)

Minimally invasive mucogingival procedures are really useful and predictable in order to repair soft tissue complications around implants (MP4 210,883 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gomez-Meda, R., Esquivel, J. (2022). Microscope-Assisted Implant Complication Management. In: Chan, HL.(., Velasquez-Plata, D. (eds) Microsurgery in Periodontal and Implant Dentistry. Springer, Cham. https://doi.org/10.1007/978-3-030-96874-8_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-96874-8_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-96873-1

  • Online ISBN: 978-3-030-96874-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation