SURGICAL MANIPULATION OF SOFT AND BONE TISSUE IN CONTEMPORARY DENTAL IMPLANTOLOGY
Authors: Petrovski Mihajlo , Papakoca Kiro 
Published: November 2022

Adequate and correct manipulation of soft and bone tissues during implant therapy is extremelyimportant. Knowledge of the biological, histological and of course the surgical characteristics of the tissues canlargely be a predictor of the correct implant prosthetic rehabilitation. The main aim of this research was to describeall aspects of surgical manipulation of the soft and bone tissues during the dental implantology procedures. We havemade adequate literature research for articles relevant to our topic-surgical manipulation of the soft and hard tissuesduring the dental implantology procedures published in the last two decades (2001-2021). Kew words used for theresearch were: “surgical manipulation”, “dental implantology”, “soft tissues”, “bone tissues” and their combination.Each implantologist should take into account the biological limitations of each patient, as well as the technicallimitations that may occur during the treatment. Oral soft tissues can be affected during the various stages of theimplant treatment. During the planning of a surgical intervention such as the placement of an implant, regardless ofwhether it is an immediate or a delayed loading implant, it is necessary to have an adequate manipulation of thesurrounding soft tissue and bone structures. When designing the flap should be taken into account the degree ofaccessibility required to access the bone, as well as the final position of the flap. It is also of great importance to takeinto account the preservation of good blood supply to the flap. Based on the exposure of bone after elevation, flapscan be classified as either full-thickness or mucoperiosteal flaps and partial-thickness or mucosal flaps. Dependingon how the interdental papilla will be treated, the incisions can either divide the papilla (conventional incision) orpreserve it (papilla-preserving incision). Based on the placement of flaps after surgery, they can be classified as: 1)nondisplaced flaps, where the flap is returned and sutured to its original position, or 2) displaced flaps, which areplaced apically, coronally, or laterally from their original position. The work in bone is quite complex and requiresknowledge of its morphological and histological characteristics. When working on bone, and especially whenplacing dental implants, it is necessary to note that it is necessary to enable constant cooling. The improvement ofold techniques and the development of new technologies have created a revolution in oral implantology, and now atherapist has numerous therapeutic options that can be incorporated into daily practice to facilitate the surgicalapproach itself. Hard-tissue and soft-tissue dental lasers, which are constantly improving and have a wide range ofindications, are becoming a part of everyday dental practice and also show significant advantages compared toconventional instruments and techniques when placing dental implants. Therefore, over time they will become aninvaluable and irreplaceable tool in modern dental implantology. After the performed extensive and deductiveliterature review, it can be concluded that from particular importance is the correct manipulation of soft and bonetissues during dental implantation. After tooth extraction, the placement of dental implants is largely determined bythe integrity of existing hard and soft tissues, such as the aesthetic outcome from the prosthodontic suprastructureover dental implants. Careful assessment of soft and bone tissue loss during implantation is paramount to the successof aesthetic implant procedures