Clinical Complications in Fixed Prosthodontics: Causes, Prevention, and Management Part 4
You will receive 2 credit(s) of continuing education credit upon successful completion of this course. The purchase price of this course is $98.00


Part 4: Soft Tissue and Esthetic Complications with Dental Implants

Soft tissue complications present biologic problems that can lead to bone and implant loss and this presentation will discuss the factors that cause such problems occur and how they could have been minimized or avoided.


Learning Objectives:

Upon completion of this course, the participant should be able to:

  1. Identify the types of soft tissue complications that occur with dental implants and their incidence.
  2. Know how to avoid or minimize these complications.
  3. Understand contemporary cementation guidelines regarding technique and materials.
  4. Discuss the space required for appropriate implant placement.
  5. Describe the bioesthetic guidelines for anterior teeth.
  6. Predict interproximal soft tissue esthetics prior to implant placement.
  7. Predict midfacial soft tissue esthetics prior to implant placement.
  8. Know the factors that cause mucosal recessions and methods of minimizing recession.
  9. Describe the crown contours that promote favorable soft tissue positioning.
  10. Understand facial growth changes that occur during adolescence and continue throughout life.


Soft tissue complications present biologic problems that can lead to bone and implant loss.  In the anterior esthetic zone of patients with high smile lines, unesthetic soft tissue changes can occur that require special knowledge to avoid the changes.  This presentation will identify how biologic and esthetic mucosal problems occur and how they could have been minimized or avoided.

  1. Incidence of implant fenestration/dehiscence
  2. Incidences and causes of gingival inflammation/proliferation
  3. Incidence and causes of fistulas
  4. Effect of residual cement on fistula development
  5. Cementation guidelines
  6. Space requirements for implant placement
    1. Space required between adjacent teeth
    2. Space required between implant and adjacent natural teeth
    3. Space needed between adjacent implants
  7. Bioesthetic guidelines for anterior single implants
    1. Mediolateral implant positioning guidelines
    2. Apical implant positioning guidelines
    3. Faciolingual implant positioning guidelines
    4. What bone grafting does and does not do
  8. Challenges associated with the peri-implant mucosa and interdental papilla
  9. Predicting interproximal soft tissue esthetics
    1. Effect of periodontal biotype
    2. Effect of distance from interproximal bone crest to proximal contact
    3. Effect of adjacent natural tooth or implant
    4. Effect of long epithelial attachments
  10. Predicting the midfacial soft tissue location after extraction and implant placement
    1. Incisocervical location of midfacial bone crest
    2. Incisocervical implant location
    3. Facial implant position/angulation
    4. Proximity of implant to facial bone
    5. Faciolingual thickness of facial bone
  11. Factors causing mucosal recession around implants
  12. Methods of minimizing recession around implants
  13. Affect of crown contours on soft tissue health, position, and contours
  14. The S-shaped crown form
  15. Compromised mucosal outcomes and their management
  16. Facial growth changes during adolescence and during aging

  1. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121-32.
  2. Agar JR, Cameron SM, Hughbanks JC, Parker MH. Cement removal from restorations luted to titanium abutments with simulated subgingival margins. J Prosthet Dent 1997;78:43-7.
  3. Wadhwani C, Hess T, Faber T, Pineyro A, Chen CS. A descriptive study of the radiographic density of implant restorative cements.  J Prosthet Dent 2010;103:295-302
  4. Choquet V, Hermans M. Adriaenssens P, Daelemans P, Tarnow DP, Malevez C. Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants.  A retrospective study in the maxillary anterior region.  J Periodontol 2001;72:1364-71.
  5. Kan JY, Rungcharassaeng K, Umezu K, Kois JC. Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans. J Periodontol 2003;74:557-62.
  6. Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, Salama M, Salama H, Garber DA. Vertical distance between the crest of bone to the height of the interproximal papilla between adjacent implants.  J Periodontol 2003;74:1785-8.
  7. Daftary F, Mahallati R, Bahat O, Sullivan RM. Lifelong cranial growth and the implications for osseointegrated implants. Int J Oral Maxillofac Implants 2012;28:163-169.

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