Detailed Show Notes

Episode Overview In part one of this two-part series on Dental Digest, host Dr. Melissa Seibert sits down with dual-boarded periodontist and prosthodontist Dr. Ashley Hoders to examine the latest consensus literature on peri-implant soft tissue deficiencies, biologic bone preservation, and the biomechanics of skeletal expansion . They unpack why soft tissue recession is fundamentally a bone problem, how thin tissue starved of blood supply triggers crestal loss, and why treating skeletal arch deficiencies with dental compensation compromises cortical bone .

Guest Information

Guest: Dr. Ashley Hoders, DDS, MS
Credentials & Affiliations: Dual board-certified diplomat and fellow of the American Board of Periodontology and the American Board of Prosthodontics; MS from UT Health Science Center at San Antonio . Clinical researcher with the McGuire Institute, co-creator of Spear Hygiene, visiting faculty at the University of Washington Graduate Periodontics Department, and active member of the American Academy of Restorative Dentistry (AARD) .

Key Clinical Takeaways

1. The Reality of Peri-Implant Soft Tissue Deficiencies

Recent joint consensus papers (AO/AAP) reveal that non-diseased peri-implant soft tissue deficiencies have an overall prevalence of 46.2% .
These deficiencies worsen over time: 33% at 1 year and 64.5% at 5 years .
Clinicians should exercise caution when planning implants in the aesthetic zone and consider alternative modalities (such as resin-bonded bridges) when appropriate .

2. Mid-Facial Margins vs. Interproximal Papilla

Interproximal papilla height is dictated primarily by the bone levels on adjacent natural teeth .
Mid-facial mucosal margin stability is driven by facial bone thickness (which is frequently $<1\text{ mm}$), 3D implant positioning, and placement timing (immediate vs. delayed protocols) .

3. Soft Tissue Recession is an Underlying Bone Problem

Soft tissue recession or peri-implant deficiency cannot occur without an underlying bone dehiscence or bone loss .
Bone requires two primary conditions to remain stable :
- Vascular Nutrition: Thin tissue has inadequate blood supply, starving the underlying crestal bone and causing progressive remodeling .
- Absence of Tension: Muscle attachments, vestibular pull, and lack of keratinized tissue exert tensile forces that destabilize bone .

4. Proactive Grafting as a Bone Stabilizer

Because bone cannot be predictably regenerated over an avascular implant surface or root dehiscence, soft tissue grafting serves as a proactive biologic shield .
Converting thin phenotypes to thick biotypes and widening keratinized mucosa delivers blood supply and buffers muscle tension, safeguarding crestal bone before recession occurs .
5. Skeletal Solutions for Skeletal Discrepancies
- Post-industrial human development (diet changes, decreased breastfeeding) has led to smaller maxillas and contracted arches .
- Treating skeletal constriction with purely dental expansion tips teeth outside the cortical plate, causing bone dehiscences, severe recession, and mobility .
- Skeletal discrepancies require orthopedic/skeletal solutions (e.g., MARPE) rather than dental camouflage to preserve the periodontal foundation .
6. Patient Communication & Treatment Planning
- Utilize 2D/3D radiographs alongside high-quality clinical photographs at baseline .
- Drawing directly on printed photos helps patients visualize bone anatomy, soft tissue margins, and long-term aesthetic trade-offs before consenting to anterior implant therapy .
Notable Mentions & Literature
- Consensus Literature: Academy of Osseointegration (AO) and American Academy of Periodontology (AAP) consensus papers on peri-implant disease and soft tissue deficiencies .
- Influences & Citations: Kevin Murphy (AARD literature review), Joseph Kan (interproximal bone dynamics), Mariana Evans (airway, cranial growth, and post-industrial skeletal changes), Jeff Rouse, and Bill Robbins (interdisciplinary diagnosis)