Flap design, suturing, and healing

Tissue management is an integral and essential component of implant care. With the evolution of implant dentistry, the functional osteointegration of the implant to the recipient site is no longer considered an adequate measure of a successful outcome of therapy. The restoration of health, function, comfort, and aesthetics are parameters to be considered in the outcome of care. This becomes particularly significant in the anterior maxillary area where the expectation is that reconstructions must be indistinguishable from natural teeth. Different materials and surgical and restorative techniques are continuously being developed and tested to achieve this objective. Surgical tissue management, including soft tissue management, incision design, and suturing, and knowledge of anticipated healing outcomes are essential for a successful aesthetic outcome. This chapter describes flap design, papilla reconstruction techniques, management of soft tissue toward enhancement of attached gingiva, suturing materials, types of needles, types of knots, suturing techniques, and the various phases of soft tissue healing. A well thought-out surgical plan of flap design at every stage of implant surgery is critical to preserve and/or enhance the aesthetics and health of anterior implant restorations. Knowledge of the factors that affect flap design, suturing techniques, and the principles of healing are paramount in obtaining an ideal aesthetic result of an implant restoration that is indistinguishable from adjacent natural dentition.