Immediate Implant Placed too Labial gets saved by Soft Tissue: No Graft Needed

If you don’t believe me than please divert your attention to Dr Danny Melker and his 40+ years of documentation of the importance of adequate soft tissue.

Probably the best explanation I can give is related to teeth...... When a tooth has no attached gingiva and/or recession we recommend a soft tissue graft. Why not a bone graft since the exposed root lacks bone? The reason is because bone grafting, with or without a membrane, over an avascular root is extremely unpredictable. With soft tissue we know it provides a strong seal and can survive over an avascular root when only 80% of the graft is covered by the flap. Since we all recognize the importance of a "soft tissue seal" around a tooth shouldn't we assume, at least until proven otherwise, that the same applies to an avascular implant. Yes with a thin buccal plate thick soft tissue will save you.

Thank you for your comment. I start to understand the point of your discussion. I think there are some key issues: 1 if gingival tissue covering an implant with no bone is going to work then it needs to be the right type of gingiva. eg thick, keratinised and possibly the right genetic make up 2 irrespective some buccal bone would be desirable 3 I suspect that the type of implant surface is critical. I think we have all seen deep (irreversible) gingival pockets around implants (especially buccal) where the implant surface is rough/threaded (or both) and not able to be properly cleaned. A successful outcome in such a situation is unlikely long term 4 in the case you reviewed, I still suspect there was buccal bone present (albeit possibly thin). This is why I requested radiographic evidence of what was on the buccal aspect of the implant. Without this knowledge, it is impossible to say accurately whether the gingival tissue survived because it was strong, thick gingival tissue (and maintained well) or whether there was buccal plate that was assisting the stability 5 with these points considered, I am not sure your comment that "soft tissue saved the case" can be presumed because it may be that bone was involved also Therefore while I understand and agree that soft tissue is important (indeed critical) to the success of an implant, I am not certain that you can say your case proves the point that soft tissue is all that is required unless you can show that no bone was present. It would be unwise to jump to a possible false conclusion. Irrespective of the above, I repeat that this case shows a good result and your surgery was well done.