Uncovering dental implants with simultaneous peri-implant soft tissue reconstruction: a case report

Objectives: The aim of this case presentation was to evaluate the effectiveness of a surgical technique combining vestibuloplasty, and free gingival graft (FGG) transplantation at the same time as uncovering dental implants. Methods: The patient exhibited inadequate soft tissue condition at the buccal aspect of submerged dental implants (45, 46), 3 months after implant insertion: shallow vestibular fold and less than 1 mm, unstable keratinized mucosa (KM) were present. Following local anesthesia a crestal incision was made above submerged implants, continued in a paramarginal incision at the neighboring dentition. Split thickness flap was elevated, and fixed with resorbable sutures to the underlying periosteum 5-7 mm apically from the incision line. After uncovering the implants, temporary abutments were mounted. A FGG was harvested from the palate, adjusted to cover the exposed periosteal layer, and fixed with resorbable sutures to the underlying periosteum, and to the surrounding KM. Periodontal dressing was applied for 7 days at implant site, palatal donor site was covered with an absorbable collagen fleece fixed with mattress sutures. Sutures were removed 14 days postoperatively. Results: 2-3 mm keratinized mucosa was observed at the buccal aspect of 45, 46 dental implants, with no signs of inflammation. 3 months postoperatively, final restauration was cemented. Reestablished soft tissue conditions helped to prevent bacterial irritation resulted from masticatory movements, and helped the patient in oral hygiene maintenance. Conclusions: The presented combination of vestibuloplasty and FGG resulted in a stable, soft tissue environment around dental implants in the presented case. Further investigation needed to compare surgical modalities aiming to create KM around submerged dental implants. Parole chiave: uncovering implants, FGG, vestibuloplasty, soft tissue reconstruction, periimplantitis