J Periodontal Implant Sci.  2014 Apr;44(2):94-99. 10.5051/jpis.2014.44.2.94.

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

• Sohn JY
• Park JC
• Cho KS
• Kim CS

• KMID: 1914510
• DOI: http://doi.org/10.5051/jpis.2014.44.2.94

Abstract

PURPOSE
Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the long-term outcome of this grafted gingiva.
METHODS
A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap.
RESULTS
At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue.
CONCLUSIONS
Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.

Keyword

Free gingival graft; Interpositional onlay graft; Keratinized tissue; Nonsubmerged implant

MeSH Terms

Dental Implants
Follow-Up Studies
Gingiva
Humans
Oral Hygiene
Palate
Transplants*
Dental Implants

Figure

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  Figure 1 Preoperative clinical photographs and radiograph. (A) Occlusal view of the edentulous ridge of the right mandibular area. The dotted line indicates the buccal and lingual mucogingival junctions. (B) Buccal view. (C) Slight vertical bone resorption was observed in the posterior area.

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  Figure 2 The recipient site preparation. (A) The dotted line represents the horizontal incision line. (B) Healing caps were connected after installing the implants. (C) The template for guiding the palatal incision was constructed from tinfoil.

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  Figure 3 The palatal donor site preparation. (A) The incision for the graft was carried out using a tinfoil template. (B) A presuture was created for immediate adaptation and fixation, and then, the interpositional free gingival graft, containing connective tissue, was harvested from the palate. (C) A three-dimensional schematic view of the graft. The partial-thickness graft consists of an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion.

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  Figure 4 Placement of the interpositional free gingival graft (FGG). (A) The interpositional FGG was positioned over the recipient bed, and the connective-tissue-only portion was inserted under the buccal flap. The presuture silk was tied around the healing abutments using the sling suturing technique. (B) The buccal and lingual flaps were sutured with grafted gingiva, and primary closure was obtained. (C) Occlusal view after 1 month of healing.

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  Figure 5 Healing states of the grafted gingiva after 1 year and 8 years. (A) Buccal view after 1 year of healing. (B) Buccal view after 8 years of healing.

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  Figure 6 Periapical radiographs of the implants after 1 year and 8 years. (A) Postoperative, 1 year. (B) Postoperative, 8 years. Saucerization occurred around fixtures, but there was no additional alveolar bone resorption in the interproximal area up to the 8-year follow-up.

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