| Studies on the success rates of implant dentures consider the survival time of the implant and sometimes the rate of peri-implant bone loss, but rarely take into account aesthetic aspects of the implant restoration. However, for many patients, successful dental implant treatment must result in a functionally as well as aesthetically acceptable outcome. Factors of importance for implant aesthetics include the anatomy of the implant recipient site, the position of the implant in the jaw and the soft tissue management procedures during the various phases of implant placement and restoration. The soft tissue that frames the restoration contributes greatly to the overall appearance of the restoration. To maximally preserve the peri-implant soft or hard tissues, each phase of rebuilding the implant site, placing the implant and managing the soft tissue must be carefully considered. For stage 1 and stage 2 of implant surgery, various surgical flap designs and soft tissue management procedures aim at preserving the contours of soft tissues. In addition, the provisional restorations play an important role on the shaping of the peri-implant soft tissues.This research focuses on the influence of surgery flap design and provisional restoration on peri-implant soft tissue. The clinical study was divided into three parts. The first part was to evaluate the effect of flap design of stage 1 surgery on the papillae height and interproximal crestal bone loss around single-tooth implants. The second part was to observe the influence of crestal rotated flap on the papillae height and width of attached gingiva around single-tooth implants in the esthetic zone of maxillae. The third part was to evaluate the provisional restorations in soft tissue management around dental implants in the anterior maxillae.Part one Influence of flap design of stage 1 surgery on the papillae height and interproximal crestal bone loss around single-tooth implantsThe surgical trauma delivered to soft and hard tissues during implant placement can influence the future esthetic result. The clinician should use surgical techniques that prevent esthetic complications, such as loss of interdental papillae. This prospective study investigated the loss of interdental papillae and interproximal crestal bone loss occurring after placement of single-tooth implants using two different flap designs: the conventional technique with a widely mobilized flap that included the interdental papillae, and a limited flap design that protected the interdental papillae. This study included 43 patients, 45 submerged implants were selected for which the flap design was wide (WF) on one side (mesial or distal) and limited (LF) on the other. Radiographs were used to determine the interproximal crestal bone height, impressions were taken and stone models were used to evaluate the loss of papillae. After three months, the mean interproximal bone loss and papillae loss were 0.13+ 0.07mm, 0.16+0.08mm in the LF sites and 0.17+0.09mm, 0.65+0.20mm for the WF sites. The papillae and interproximal crestal bone loss were of statistically significance less following the use of a limited flap design versus the widely mobilized flap procedure by the Students' t test for paired data. The use of a limited flap design for single-tooth implants is indicated to avoid possible loss of the papillae and minimize interproximal crestal bone loss. Good esthetic outcomes can be achieved predictably when the corresponding surgical technique and principles described above are used.Part two Effect of crestal rotated flap on the papillae height and width of attached gingiva around single-tooth implants in the esthetic zone of maxillaeSoft tissue management is considered to be one of the paramount factors in achieving the optimal required final result. This prospective study investigated the height of interdental papillae and width of attached gingiva around single-tooth implants in the esthetic zone of maxillae after exposure of implant using crestal rotated flap. The study comprised 41 implan...
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