Mucogingival Plastic Surgery applied to solve peri-implant soft tissue defects in esthetic area

Michele Perelli

Author
Dr. Michele Perelli

Turin, Italy



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A young patient, female, had an implant positioned in site 22.
This picture shows the second surgical time with the uncovering of the screw. Note the free gingival margin level around the healing abutment.


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A provisional screw-retained crown was placed.

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After 2 months an important periimplant soft tissue recession occurred. Note also the soft tissue’s concavity in the lateral view. This recession strongly compromised esthetic results.

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Treating the implant as a tooth, mucogingival plastic surgery principles were applied. A splint- full thickness flap without vertical incisions was scalloped.

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Periimplant soft tissue needed to be augmented in thickness and coronally replaced.

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After partial- full thickness flap a free gingival epithelial-connective tissue graft was taken.

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The graft was de-epithelized and placed apically to the adjacent teeth CEJ.

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It was fixed to the recipient connective bed with glue (without sutures).

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After periosteal incisions the flap was coronally repositioned and the surgical papillaes were sutured on the clinical papillaes. The free gingival margin was replaced at the same level of the contralateral tooth.

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Sutures were removed after 15 days. Note the soft tissue margin level, the color and the external textures as well as the augmented thickness.

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1 year follow-up radiography. The coronally advanced soft tissue is stable around the provisional crown with good blending with adjacent teeth soft tissues. Pink and White esthetic is gained.

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Pre-op frontal view

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Post-op frontal view

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Pre-op lateral view

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Post-op lateral view

Treating the implant as a tooth, mucogingival plastic surgery principles were applied. Periimplant soft tissue needed to be augmented in thickness and coronally replaced. 

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