Soft tissue management surrounding dental implants could be divided into two parts: functional reconstruction and aesthetic management.

Functional reconstruction is to regain normal soft tissue structure, for example, attached gingival surrounding dental implants, in order to gain long term stability; Aesthetic soft tissue management is to try achieving aesthetic implant result through soft tissue plastic operation in front teeth area which is so-called aesthetic zone. More and more patients require not only function but also aesthetics through implant therapy, therefore to get long-term osseointegation; function and aesthetics are becoming the most important aim of current dental implantology.

Soft tissue surrounding implants should be similar to the periodontal soft tissue in topography which is including alveolar surface geography, soft tissue color, marginal gingival line, interproximal papilla, enough width attached gingival and so on. Pre and post operation scar, hard and soft tissue defects, alveolar tissue resorption are common factors resulting in soft tissue changes.

From Oct.1996 to June.2009, 861 cases underwent soft tissue reconstruction and esthetic management surrounding implants in implant Center of Peking University. 171 cases had soft tissue reconstruction and 690 cases with esthetic soft tissue management. Mean follow up is 49 months. Mean 4 mm (ranged 3-9 mm) so called attached gingival width was reconstructed. In aesthetic zone with 690 case, 31 cases reached papilla height class I, 490 cases in class II, 169 cases in class III and 0 cases in class IV according to Jemt classification. Free mucosa flap had necrosis in 3 cases, and free mucosa flap had about 30% - 50% shrinkage from original size.

The key problem was deficient soft tissue volume and attached gingival lost in implant area, because exist and enough soft tissue can only be modified. Free mucosa flap, connective tissue flap, local slide flap, local rotation flap, were performed to reconstruct soft tissue topography. Provisional crown and special designed abutment were used to conduct gingival form and papilla.

Based on this result, we come to conclusion: soft tissue reconstruction and esthetic management are a challenge in current implantology worldwide; following efforts are recommended in every surgical step:

1. Trying to reconstruct hard tissue volume before or simultaneously in implant operation including various augmentation techniques as well as alveolar vertical distraction osteogenesis, because the support of hard tissue is the prerequisite of soft tissue reconstruction
2. Trying to reconstruct enough soft tissue volume in every step including various local tissue flaps as well as free tissue transplantation, because only enough tissue could be modified
3. Trying to reconstruct or improve width of attached gingival including sliding flap, free gingival flap and so on, because it is helpful for long term stability of osseointegration
4. Trying to place implants in right position in 3-dimension, which is one of most important factors effecting esthetics
5. Delivering a provisional prosthesis is helpful to form soft tissue topography.

All details of indication, clinical techniques, strategies, special management, results and problems will be discussed in presentation.