Management of Peri-Implant Soft Tissue Deficiency Around an Implant Placed During the Adolescent Period: A Case Report

Background: A 21-year-old systemically healthy male patient referred to our clinic with a complaint of aesthetic appearance of anterior teeth having a temporary removable prosthesis. Following clinical and radiological examinations a passive implant body was detected in the area of tooth #21 with vertical and horizontal soft and hard tissue deficiencies. The patient's history revealed that he lost the tooth due to trauma at the age of 15 and received an implant during his adolescency period, shortly after the loss. Following CBCT imaging, a treatment plan was made in consultation with the prosthodontics department.
Description of the procedure: Following non-surgical peri-implant/periodontal therapies two consecutive connective tissue graft surgeries were performed to compensate the soft tissue deficiency on the buccal side. The postoperative period was uneventful following both surgeries. The gingiva was recontoured using a custom abutment and a temporary prosthesis, with follow-up for three months. The final abutment has been anodized to prevent the metallic appearance of titanium from reflecting through the permanent restoration. Digital color measurement was taken from the symmetric tooth #11 using a colorimeter to achieve aesthetic harmony. The final restoration was fabricated by milling from a monolithic zirconia block (GC Initial, Switzerland®). The fabricated final restoration was adhesively cemented onto the abutment, and occlusion checks were performed.
Outcomes: Horizontal soft tissue deficiency successfully compensated with surgical and prosthetic approaches. The patient was satisfied with the result, regaining his aesthetic and functional loss.
Conclusions: It is crucial to wait for the jawbone to complete its growth before implant placement. Adequate peri-implant soft tissue is vital to achieving optimal functional and esthetic results of implant treatments.