Periodontal, Functional, and Esthetic Integration of Peri-Implant Soft Tissue: WHS Concept

Abstract

The long-term functional success of implant treatment depends on the stability of the crestal bone around the implant platform. The esthetic result is achieved by adequate quality and quantity of soft tissue in the peri-implant area. The soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain in the long term, not only implant osseointegration, but also the integrity of the soft tissue around the sub- and suprastructures of the implant restoration. To create the protective soft tissue area, it is necessary to ensure 3 criteria. This treatment approach will be defined as TWS-soft tissue management: T for thickness, W for width, and S for stability. There are many ways to achieve the first 2 criteria, which are described in the literature. Achieving the third criterion of stability has become possible only recently because of the development of digital treatment planning, surgically guided, and prosthetic-assisted technology that uses a 1-time abutment and its implementation into the dental practice. The purpose of this article is to present with clinical cases a detailed description of each criterion.

Keywords: biological width; dental implantology; gingival thickness; keratinized attached gingiva; muco-gingival integration; navigational implantology.