Implantoplasty combined with soft tissue grafting for the management of complex cases: A microsurgical approach

BACKGROUND: The treatment of peri-implantitis and/or peri-implant soft tissue dehiscence defects (PSTD) remains challenging. The incorporation of the operating microscope (OM) into surgical procedures might have changed the treatment landscape for such conditions around implants. The aim of this case series is to present three clinical cases in which the combination of connective tissue grafting (CTG) and implantoplasty was performed under microscopy and served as the key tools for managing complex cases. METHODS: In this article, the authors illustrate three distinct cases in which the combination of CTG and implantoplasty was used as a single or double-staged approach for the treatment of PSTD, combined or not with peri-implantitis. Importantly, the OM was used as a critical tool to increase precision and reduce trauma. RESULTS: Overall, all procedures successfully preserved implants up to 3 years in highly compromised conditions. The approaches achieved a reduction in mucosal recession of up to 2 mm and successfully increased the thickness of the soft tissues. In addition to the maximum precision combined with the lesser trauma, the OM was critical for allowing delicate flap elevation of extremely thin tissues, achieving the smoothest implant surface with minimal wear, and permitting intimate adaptation of the CTG to the recipient bed. CONCLUSION: The OM combined with advanced skills for surgeons facilitated critical steps of the surgical procedures. Microsurgery combined with implantoplasty and connective tissue grafting offers an effective alternative for managing supraosseous or exposed implant threads caused by peri-implant disease or poor implant positioning. KEY POINTS: Limited evidence supports implantoplasty with connective tissue grafting for complex implant complications, especially in esthetic areas. This case series shows implantoplasty aids decontamination and also reduces buccal implant volume, while connective tissue grafting enhances peri-implant soft tissue thickness. The microsurgical approach was fundamental to treatment success. It improved precision, minimized trauma, and promoted better healing and lower morbidity. PLAIN LANGUAGE SUMMARY: This group of cases shows that using a combination of implant surface polishing (implantoplasty) and soft tissue grafts, done with a precise microsurgical technique, can be an effective and less invasive way to treat complicated cases, without needing to remove the implant.