JOURNAL CLUB PRESENTATION
NEW HORIZON DENTAL COLLEGE AND RESEARCH INSTITUTE
DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE
JOURNAL CLUB PRESENTATION
TOPIC-
CREATION OF INTER IMPLANT PAPILLAE THROUGH A SPLIT FINGER
TECHNIQUE
GUIDED BY- PRESENTED BY-
Dr. TUSHAR TANWANI Dr. Aishwarya Sharma
Dr. ANUPAM PURWAR PG Student
Dr. ANKITA PIPLANI
Dr. GAURAV AGRAWAL
Dr. SUDEEPTI SONI
Dr. POOJA AGRAWAL
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JOURNAL CLUB PRESENTATION
• Introduction
Dental implants have been successfully used to replace missing teeth
one remaining challenge is building/maintenance of papillae around dental implant
Traditional soft tissue papilla reconstruction techniques:
tissue-punch technique - the crestal tissue height is often leveled with the interproximal
height. Hence, this subtraction technique does not result in an ideally scalloped appearance
that should form the soft tissue drape required in the esthetic region.
full-thickness flap technique - with a crestal incision is often used in nonesthetic regions or
for implant overdentures.
However, tension created by the sutures on the facial and lingual flaps in the interimplant
areas often results in a negative soft tissue profile, because the midimplant areas have
elevated tissue and the interproximal regions are depressed
• Three Different Approaches
1. SUBTRACTION TECHNIQUES removes tissue to sculpt the emergence contour.
Typically, this technique used by itself results in interimplant papillae with a reduced height.
ADDITIVE TECHNIQUE increases the soft tissue of existing architecture to increase the
interdental/interimplant papilla primarily in height.These techniques have often recquired a
second surgical site.
roll technique- uses a deepithelialised connective tissue graft
connective tissue grafts: wedge of connective tissue with overlying epithelium is harvested
from the palate and inserted betweenb the flap and the edentu;loius site
IMMEDIATE IMPLANT INSERTION attempts to maintain the existing tissue architecture.
However, this approach can only be used in a noninfected extraction site with intact bony
walls and often results in 1 to 2 mm of soft tissue recession after 1 year.
• Misch: suggested the crest and interproximal region of the ridge should be augmented
with dense hydroxyapatite at implant surgery to elevate the soft tissue to the height of
the desired interdental/ interimplant papillae
• An alternative to this approach
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JOURNAL CLUB PRESENTATION
• Palacci: surgical technique, semi lunar beveled incision technique was very effective
in providing a scalloped appearance to the soft tissue drape around the abutments
• Nemkovsky: incision: U shaped incision with divergent arms, used the soft tissue over
the implant site to augment the papillary form
• Two staged Submerged Implant Placement
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JOURNAL CLUB PRESENTATION
• OSTEOTOMY
• PURPOSE OF THE ARTICLE
• To present an alternative additive technique, which increases soft tissue height at the
interproximal region to enhance the esthetic result of single or multiple dental
implants.
• The procedure can be used at one-stage implant placement or at second-stage surgery.
• Connective tissue or alloplastic grafts could be used in conjunction with the procedure
to further increase the soft tissue contours in the interproximal regions.
• MATERIAL AND METHODS
• The procedure outlined uses a “split-finger” approach to create both a cervical
emergence and an elevated inter-dental/inter-implant soft tissue.
• The manipulation of both palatal and facial soft tissues provide sufficient additional
tissue volume to further increase the interimplant papillae height
• 21 PATIENTS; 39 IMPLANTS
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JOURNAL CLUB PRESENTATION
• Placed in anterior region of maxillary arches, evaluated at 6 months to 1 year after
function
• INTERDENTAL PAPPILA: 60
single maxillary ant teeth: 32
multiple implants: 28
• 16: single tooth
1: two unit
2: four unit
1: six unit
1:seven unit
• INTERPROXIMAL GINGIVAL INDEX (JEMT)
CLASS 0 no papilla
CLASS 1 less than/= 50% ht of gingival embrasure
CLASS 2 more than 50% but less than 100%
CLASS 3 complete closure of proximal space
CLASS 4 overgrowth of the inter proximal tissue
The surgical technique used by the authors in the clinical application of this procedure first
designs 3 interlacing “fingers” over and adjacent to each implant site and is extended around
each adjacent tooth.
• Surgical technique
• Antibiotics have not been prescribed in these clinical cases unless signs or symptoms
of infection are observed. Patients have been instructed to rinse with a 0.12%
chlorhexidine gluconate mouth rinse for 4 to 6 weeks.
• Sutures are removed 10 to 14 days after surgery.
• POST OPERATIVE CARE
• Antibiotics have not been prescribed in these clinical cases unless signs or symptoms
of infection are observed. Patients have been instructed to rinse with a 0.12%
chlorhexidine gluconate mouth rinse for 4 to 6 weeks.
• Sutures are removed 10 to 14 days after surgery.
• RESULTS
• IDEAL GOAL OF IMPLANT SUPPORTED PROSTHESES: to restore normal
contour, function, comfort, esthetics, speech and health
• ESTHETIC GOAL: gingival margin at midtooth region- 4.5 mm below the height of
interdental papillae- additive techniques
• In the results, average score represents- restoration >85% ideal tissue height
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JOURNAL CLUB PRESENTATION
• interproximal bone next to natural tooth is closer to the crown interproximal contact -
makes the esthetic soft tissue drape more predictable
high success rate for anterior single tooth implants
• soft tissue graft can be used in conjunction with this technique to further increase soft
tissue thickness
DISCUSSION
• Traditional Techniques: 1-2 mm elevation compared to midfacial gingival margin ; as
no additional soft tissue gained from the palate
Split Finger Technique: papilla is formed with tissue from both facial and palatal
aspects
• effect of final restoration: interproximal contact is brought closer to the tissue, by
elongation of contacts-class 2 papilla changed to class 3
CONCLUSION
The proposed split finger technique appears to provide an alternate procedure to promote or
augment papillae formation around dental impants.
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