Soft tissue management in aesthetic implantology: clinical case with 15-year follow-up

OBJECTIVES: Implant therapy is widely recognized as an effective and predictable solution for replacing missing teeth, supported by extensive scientific evidence. From the patient’s perspective, the success of implant therapy is assessed not only based on the long-term functionality of the implant but also on the immediate aesthetic result and its stability over time. The objective of this article is to describe the key steps for proper implant placement, bone reconstruction, and the correct management of soft tissues to ensure an aesthetically functional outcome with long-term follow-up.

MATERIALS AND METHODS: A 57-year-old female patient presented with persistent pain in tooth 1.3 and significant gingival recession, leading to the extraction of the tooth. A Free Gingival Graft (FGG) was performed to stabilize the site and promote healing, using a minimally invasive technique to preserve
the alveolar wall. After four months, a 3.5 mm implant was placed with Guided Bone Regeneration (GBR) using a combination of deproteinized bovine bone and autologous bone. Eight months post-surgery, a Connective Tissue Graft (CTG) was applied to enhance gingival contour. The final prosthetic rehabilitation included a screw-retained zirconia crown, with successful follow- up showing healthy peri-implant tissues and minimal bone loss.

CONCLUSIONS: The results of the study demonstrate the long-term success of the combined surgical and prosthetic techniques used in the case. One year after the final rehabilitation, the peri-implant tissues remained healthy, with a stable gingival profile, without signs of inflammation or significant bone loss. At 5-, 10- and 15-year follow-up, the soft tissues showed morphological and dimensional stability, with minimal marginal bone resorption. These results highlight the effectiveness of integrating mucogingival, regenerative and prosthetic techniques in ensuring lasting functional and aesthetic results.
The multidisciplinary approach adopted ensured long-term stability in hard and soft tissue, highlighting patient satisfaction with the aesthetic and functional results. This demonstrates the effectiveness of combined mucogingival, regenerative and prosthetic techniques. The results emphasize the importance
of integrated planning and treatment to address similar clinical complexities, ensuring optimal patient outcomes.

CLINICAL SIGNIFICANCE: The article highlights how hard and soft tissue management is crucial for aesthetic and functional stability in implant therapies, particularly in visible areas. By using soft tissue grafts and biomaterials, bone volume and structure can be maintained after extraction, reducing the risk of bone resorption. This technique improves peri-implant tissue stability, preventing complications and optimizing implant health and the final aesthetic result.

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