The Interimplant Papilla
before it starts a remodeling path. (See Figures 8.22A–D.) The use of a minimally invasive second-stage surgery has revealed successful postoperative results. For instance, using narrower platform implants with the healing abutments connected to it at the time of implant installation and attempting a complete soft tissue closure on top of it has revealed clinical success due to the relationship between platform switching and the formation of biological width. It is only in cases of periimplant papilla conditions that limited incision lines to the keratinized bands at the time of the second-stage surgery have led to enhanced postoperative results. Misch and others (2004) introduced the split finger technique to bulk the soft tissue around a peri-implant papilla. The method has shown high predictability and clinical efficiency. It entails reflecting a palatal flap at the time of the second-stage surgery and splitting it into two halves, then suturing each half to the labial closest flap.
A Figure 8.22A. Preoperative view of a black triangle between two implantsupported restorations.
B Figure 8.22B. The connective tissue graft is interceded and secured to the site.
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Adriaenssens and others (1999) described a similar approach to enhance the papilla formation around dental implants in the second-stage surgery in both single- or multiple-teeth situations. The method is called the Palatal Sliding Strip Flap and it helps form the papillae between implants and between natural teeth in the anterior area of the maxilla. The flap is designed and managed so that the palatal attached mucosa slides in a labial direction to create papillae and at the same time augment the labial ridge. The procedure entails an incision that allows the dissection of the masticatory mucosa from the underlying bone with a full-thickness sulcular approach in a labiopalatal direction perpendicular to the ridge crest, both on the mesial and distal aspects of the implant. A full-thickness horizontal incision is extended from the distal to the mesial on the palatal side comprising approximately two-thirds of the distance between the two teeth. Two incisions are then made parallel to each
C Figure 8.22C. Free gingival graft is placed to prevent tissue creeping.
D Figure 8.22D. Final case resorted with moderate improvement in the papillary levels.