Monday, October 31, 2011

Episode 203/500: How do you increase attached gingiva?

I had never heard of this beast.  A free connective tissue graft? A who?  I'd heard of free gingival grafts, but free connective tissue?  Well, I just post op'd a 2 month result.

The main problems, concerns w/ free gingival grafts are:
  1. Post operative pain
  2. Tire patch appearance
  3. Hair growth?  Just kidding...that's really old school when they used dermis (skin)
This patient had no attached gingiva on the facial aspect of implant #29 (FDI #45).  I inherited this case a number of months ago, to restore implant #29.  After placing the crown and completing endodontic therapy tooth #31(#47), we elected give the implant some attached gingiva.  The literature is controversial regarding attached gingiva and implants.  Some studies say none is needed to prevent peri-implantitis - others say that it is mandatory.  See the few articles below

I used a Free Connective tissue to increase the band of attached gingiva for #29 (in the following case).  The patient reported no pain postoperatively.  We gained approximately 4mm in attached gingiva on the buccal of #29.  I was excited.



Post crown placement. We elected to provide a band of attached gingiva through
a Free Connective Tissue Graft on the facial of implant #29
Sorry about the rotation.  This is elevating the Split Thickness Flap
on the Facial of Implant #29
Harvested Connective Tissue and Adipose tissue removed.

Suturing the harvested Connective Tissue Graft - it was my first CT graft
Go easy on the's tough suturing to periosteum.

No, it's not dead.  Only surface necrosis 3 days out.

2 months postoperative.  We now have a 4mm band of attached gingiva.

....the next segment on how I restored implant #29 (same case)

Turns out that in 1975, this article was published regarding Free CTGs - why the secret so long?

The use of a free connective tissue graft to increase the width of attached gingiva
Alan Edel M.Sc., B.D.S. Corresponding Author Contact Information, L.D.S.R.C.S.(Eng.)
Oral Surgery, Oral Medicine, Oral Pathology
Volume 39, Issue 3, March 1975, Pages 341-346

A systematic review assessing soft tissue augmentation techniques.
Clin Oral Implants Res. 2009 Sep;20 Suppl 4:146-65.
Thoma DS, Benić GI, Zwahlen M, Hämmerle CH, Jung RE.

Is keratinized gingiva a requirement to ensure implant health?

Int J Oral Maxillofac Implants. 2009;24 Suppl:28-38.

Local risk factors for implant therapy.

Aust Dent J. 2008 Jun;53 Suppl 1:S39-42.

Biological basis for soft tissue management in implant dentistry.

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