(T12) “soft Tissue Contour Enhancement at Implant Uncovering Using Acellular Dermal Matrix and a Tunneling Technique in the Esthetic Zone: A Case Report”

Purpose of the Study: The purpose of this case report is to describe a minimally invasive approach for enhancing peri-implant soft tissue contour in the anterior maxilla by combining a tunneling technique with acellular dermal matrix during implant uncovering surgery. This method aims to improve esthetic outcomes and peri-implant mucosal stability while avoiding the morbidity associated with autogenous graft harvesting.

Methods: A 32-year-old male with a high smile line and buccal soft tissue deficiency at implant site #7 underwent soft tissue augmentation at the time of implant uncovering. Following local anesthesia, a full-thickness flap was elevated to expose the implant, and a partial-thickness buccal tunnel was prepared with microsurgical instruments to preserve papillae and vascular supply. Frenum release was performed to reduce flap tension. Two portions of rehydrated acellular dermal matrix (one vertical, one horizontal) were inserted into the tunnel and adapted to the recipient bed. The grafts were stabilized with resorbable 5-0 sutures and supported by a healing abutment, while flap margins were closed with 6-0 nylon. Postoperative instructions included chlorhexidine rinses, soft diet, and avoidance of mechanical trauma.

Results: Postoperative healing was uneventful, with minimal swelling and no graft exposure at 1 week. At 1 month, the patient reported no discomfort, and clinical examination revealed increased buccal soft tissue thickness with early volumetric improvement. At 3 and 6 months, the augmented site demonstrated stable soft tissue contour and harmonious integration with adjacent tissues. The peri-implant mucosa maintained a well-contoured profile around the healing abutment. Patient satisfaction was high, with improvement in esthetic harmony of the anterior maxilla. No complications or adverse events occurred during the follow-up period, and volumetric gains were maintained without evidence of tissue recession or instability.

Conclusion: The combination of a tunneling technique with acellular dermal matrix at implant uncovering provided a predictable and minimally invasive method to enhance buccal soft tissue contour in the anterior maxilla. The approach resulted in stable volumetric gain, improved esthetic integration, and high patient satisfaction without the morbidity associated with autogenous graft harvesting.
Clinical Implications: This technique offers clinicians a biologically sound and patient-centered alternative for peri-implant soft tissue augmentation. It reduces surgical morbidity, preserves papillae and vascularity, and achieves esthetically harmonious outcomes in cases with high smile lines and thin periodontal phenotypes.

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Books: No books cited on this study