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Book Review

Soft Tissue and Esthetic Considerations in Implant Therapy

Quinones, Carlos R. DMD

doi: 10.1097/01.ID.0000116364.32966.B7
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Soft Tissue and Esthetic Considerations in Implant Therapy Anthony G. Sclar, DMD. 282 pp. Carol Stream, IL: Quintessence Publishing Co., Inc., 2003. ISBN: 0–86715–354–7.

In Soft Tissue and Esthetic Considerations in Implant Therapy, Dr. Anthony G. Sclar presents advanced surgical techniques for preserving and restoring natural dental esthetics in implant dentistry. Dentists who are novices, or experienced experts, in implant dentistry will greatly benefit from this book. In it, the author combines original concepts and techniques with information extrapolated from the specialties of periodontology, oral and maxillofacial surgery, and plastic and reconstructive surgery. Although a major portion of the material covered is clinical in nature, a scientific basis for the use of the techniques and treatment protocols is introduced from the beginning of the book and is reinforced throughout the text.

In general, this book is very well organized with each chapter building on the information presented in the preceding chapters in a clear, superbly illustrated, and easy-to-follow format. One of this publication’s most striking features is the use of clinical photographs and diagrams that beautifully illustrate the concepts described within. The entire design and layout of the book is very pleasing to the eye and provides for an easy, informative learning session.

In chapter 1, the author first reviews and compares the anatomy of the periodontal and peri-implant soft tissues. This is followed by a discussion of the rationale and biologic basis for creating a stable peri-implant soft tissue environment.

The second chapter presents a systematic approach for the evaluation of the esthetic implant patient. In it, the author nicely and concisely describes the basic concepts of smile esthetics and smile design such as facial and dental symmetry, upper and lower lip position, incisal and occlusal plane, tooth proportions and relationships, and gingival plane and outline. He then proceeds with a bright discussion of the importance of identifying the patient’s periodontal biotype in determining the outcome of esthetic implant dentistry. Finally, anatomic considerations that adversely affect, or limit, treatment outcomes are clearly reviewed; and a new classification system for alveolar ridge defects specific to esthetic implant therapy is presented.

Chapter 3 presents practical and effective methods for the surgical management of the peri-implant soft tissues in a wide variety of case types and situations. Dr. Sclar effectively discusses basic concepts such as instrumentation for soft tissue management, criteria for optimal flap design, and the application of plastic surgery procedures in esthetic implant therapy. He proceeds to present specific flap designs and innovative surgical maneuvers for managing the peri-implant soft tissues under different clinical scenarios.

The “Bio-Col” technique for alveolar ridge preservation is the main focus of the fourth chapter. This particular chapter presents the rationale, biologic basis, clinical goals, indications, and long-term results of this technique for patients undergoing tooth removal in conjunction with implant therapy. The surgical and prosthetic protocols for the technique and its applications in esthetic implant dentistry are splendidly presented in a detailed, step-by-step fashion.

Chapter 5 discusses the basic principles of soft tissue grafting, and provides an excellent overview of various techniques and approaches used to enhance function and esthetics around natural teeth and dental implants. The logical progression from periodontal plastic surgery around teeth to the esthetic, surgical management of the peri-implant soft tissues is presented in a comprehensive yet understandable way, and is superbly illustrated with demonstrative photographs and concise descriptions that highlight the procedures. This chapter provides the basis for the successful application of oral soft tissue grafting in implant therapy and offers a very clear explanation of the indications, advantages, expected outcomes, and limitations of the most commonly used soft tissue grafting techniques such as the modified palatal roll procedure, the epithelialized palatal graft (ie, free gingival graft), and the subepithelial connective tissue graft.

An innovative technique named by the author as the vascularized interpositional periosteal-connective tissue (VIP-CT) flap is described in chapter 6. This chapter presents the rationale, biologic basis, and detailed surgical technique for the VIP-CT flap. The use of this procedure for large-volume soft tissue augmentation and simultaneous hard and soft tissue site development of deficient alveolar ridges in conjunction with implant therapy is illustrated.

The final chapter of this book presents a comprehensive approach to the surgical management of a wide selection of clinical cases encountered in esthetic implant therapy. In this section, the author introduces a philosophy for the esthetic care of the implant patient. This is followed by the detailed, step-by-step presentation of advanced cases that demonstrate the use of hard and soft tissue implant site-development techniques in correlation with the classification system for alveolar ridge defects described earlier. Various surgical and prosthetic considerations for enhancing outcomes in esthetic implant therapy such as cosmetic laser soft tissue sculpting and resurfacing, platelet-rich plasma (ie, PRP) techniques, interim provisional restorations, custom healing abutments, and custom final abutments are also discussed. Finally, a conceptual framework for esthetic implant site development is presented to provide the dentist with an understanding of the sequence and timing of the procedures. One additional, final highlight of this book is the inclusion of an Appendix containing a series of treatment-planning algorithms, which help the reader navigate through 10 of the most commonly encountered esthetic implant dentistry challenges in an abbreviated and easy-to-follow format.

In conclusion, Soft Tissue and Esthetic Considerations in Implant Therapy is perhaps the only and the most comprehensive and understandable book dedicated exclusively to the subject of esthetic soft tissue management in implant dentistry. It is, without any doubt, one that should be included in the library of every dentist involved in implant dentistry, regardless of whether he or she performs the surgical and/or restorative phases of implant dentistry. Dr. Anthony G. Sclar is to be congratulated for having taken the initiative, and pioneering, in writing and compiling this book on the topic of esthetic peri-implant soft tissue management. This text fills a large void in the clinical practice of implant dentistry.

© 2004 Lippincott Williams & Wilkins, Inc.