Correcting Mucogingival Deformities at the Time of Extraction for a Future Implant Site: A Case Report
CLINICAL ADVANCES IN PERIODONTICS
Authors: Gober, Daniel D.; Vardar-Sengul, Saynur
Abstract
Introduction: Existing soft tissue deformities around a tooth planned for extraction and replacement with a dental implant may jeopardize the esthetic and physiologic outcome of any dental implant treatment. If soft tissue deformities can be prevented, minimized, or corrected at the time of tooth extraction for the future implant site and the adjacent teeth, more predictable outcomes with superior esthetics and health can be accomplished along with fewer surgical visits. Case Presentation: This case report describes a patient who presented with mucogingival deformities around a tooth scheduled for extraction and subsequent implant placement. The adjacent tooth also presented with similar characteristics. Surgical modifications and refinements were used by performing an epithelialized free gingival graft (E-FGG) at the time of tooth extraction to enhance the tissue quality of the future implant site and its neighboring tooth. Conclusion: The identification of inadequate attached gingiva in the area of future implant placement and neighboring teeth in the treatment planning phase can enable clinicians to address any mucogingival deformities with E-FGGs at the time of extraction without subjecting the patient to any additional surgical visits and healing time.
A Modified Technique of Tacking Acellular Dermal Matrix to Increase Keratinized Mucosa Around Dental Implants as an Alternative to a Free Gingival Graft: A Case Report
CLINICAL ADVANCES IN PERIODONTICS
Authors: Shi, Ye; Segelnick, Stuart L.; El Chaar, Edgard S.
Abstract
Introduction: Free autogenous graft was the gold standard to increase the keratinized mucosa (KM) and vestibular depth. The major downfall of this technique is the postoperative morbidity at the donor site. The purpose of this case report is to demonstrate a modified technique using acellular dermal matrix (ADM) to increase the KM around implants to achieve faster healing with less postoperative morbidity. Case Presentation: Patient presented with inadequate keratinized tissue band and shallow vestibule at submerged implant sites bilaterally. Initially, surgical procedure of vestibuloplasty in conjunction with free gingival graft (FGG) was performed at one side. However, patient opted for the allograft as a substitute for the other side due to the postoperative discomfort from palatal donor site. On the left side, the FGG procedure was performed in a conventional way stabilizing with sutures. On the right side, the ADM was stabilized with tacks only at recipient site and left exposed. The new vestibule was established and stabilized with tacks. A significant gain of KM and vestibule depth was observed at the site of using ADM when compared with baseline. For the site of using FGG, KM was increased. However, the vestibule was rebounded compared with the site of using ADM with tacks. Conclusions: The use of ADM stabilized with tacks is a predictable procedure that can increase KM and establish stable vestibule around dental implants. It can lead to less chair time, faster healing, and reduced postoperative morbidity compared with autogenous soft tissue graft.