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http://dx.doi.org/10.5051/jpis.2014.44.2.94

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

Sohn, Joo-Yeon (Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry)
Park, Jung-Chul (Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry)
Cho, Kyoo-Sung (Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry)
Kim, Chang-Sung (Department of Periodontology, Research Institute for Periodontal Regeneration, Oral Science Research Center, Yonsei University College of Dentistry)
Publication Information
Journal of Periodontal and Implant Science / v.44, no.2, 2014 , pp. 94-99 More about this Journal
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 longterm 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.
Keywords
Free gingival graft; Interpositional onlay graft; Keratinized tissue; Nonsubmerged implant;
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1 Adell R, Eriksson B, Lekholm U, Branemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5: 347-59.
2 Listgarten MA, Lang NP, Schroeder HE, Schroeder A. Periodontal tissues and their counterparts around endosseous implants [corrected and republished with original paging, article orginally printed in Clin Oral Implants Res 1991Jan-Mar;2(1):1-19]. Clin Oral Implants Res 1991;2:1-19.   DOI   ScienceOn
3 Tinti C, Parma-Benfenati S. Coronally positioned palatal sliding flap. Int J Periodontics Restorative Dent 1995;15:298-310.
4 Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol 2009;36:868-76.   DOI   ScienceOn
5 Salonen MA, Oikarinen K, Virtanen K, Pernu H. Failures in the osseointegration of endosseous implants. Int J Oral Maxillofac Implants 1993;8:92-7.
6 Wennstrom JL, Bengazi F, Lekholm U. The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clin Oral Implants Res 1994;5:1-8.   DOI   ScienceOn
7 Lekholm U, Adell R, Lindhe J, Branemark PI, Eriksson B, Rockler B, et al. T. Marginal tissue reactions at osseointegrated titanium fixtures. (II) A cross-sectional retrospective study. Int J Oral Maxillofac Surg 1986;15:53-61.   DOI   ScienceOn
8 Schou S, Holmstrup P, Hjorting-Hansen E, Lang NP. Plaque-induced marginal tissue reactions of osseointegrated oral implants: a review of the literature. Clin Oral Implants Res 1992;3:149-61.   DOI   ScienceOn
9 Warrer K, Buser D, Lang NP, Karring T. Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res 1995;6: 131-8.   DOI   ScienceOn
10 Bengazi F, Lang NP, Caroprese M, Urbizo Velez J, Favero V, Botticelli D. Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs. Clin Oral Implants Res 2013 Oct 24 [Epub]. http://dx.doi.org/10.1111/clr.12280.
11 Agudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato G. Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. J Periodontol 2008; 79:587-94.   DOI   ScienceOn
12 Hatipoglu H, Keceli HG, Guncu GN, Sengun D, Tozum TF. Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series. Clin Oral Investig 2007; 11:107-13.   DOI
13 Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res 2008;19:387-92.   DOI   ScienceOn
14 Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 2013; 84:1755-67.   DOI   ScienceOn
15 Cario E. Barrier-protective function of intestinal epithelial Toll-like receptor 2. Mucosal Immunol 2008;1 Suppl 1:S62-6.   DOI   ScienceOn
16 Ericsson I, Lindhe J. Probing depth at implants and teeth. An experimental study in the dog. J Clin Periodontol 1993;20:623-7.   DOI   ScienceOn
17 Landi L, Sabatucci D. Plastic surgery at the time of membrane removal around mandibular endosseous implants: a modified technique for implant uncovering. Int J Periodontics Restorative Dent 2001;21:280-7.
18 Seibert JS, Louis JV. Soft tissue ridge augmentation utilizing a combination onlay-interpositional graft procedure: a case report. Int J Periodontics Restorative Dent 1996;16:310-21. Erratum in: Int J Periodontics Restorative Dent 1996;16:521.
19 Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410-20.   DOI   ScienceOn
20 Block MS, Kent JN. Factors associated with soft- and hard-tissue compromise of endosseous implants. J Oral Maxillofac Surg 1990; 48:1153-60.   DOI   ScienceOn
21 Bouri A Jr, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 2008;23:323-6.
22 Cairo F, Pagliaro U, Nieri M. Soft tissue management at implant sites. J Clin Periodontol 2008;35(8 Suppl):163-7.   DOI   ScienceOn
23 Lee KH, Kim BO, Jang HS. Clinical evaluation of a collagen matrix to enhance the width of keratinized gingiva around dental implants. J Periodontal Implant Sci 2010;40:96-101.   DOI   ScienceOn
24 Park JC, Yang KB, Choi Y, Kim YT, Jung UW, Kim CS, et al. A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases. J Periodontal Implant Sci 2010;40:194-200.   DOI   ScienceOn
25 Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, et al. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e24-8.
26 Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res 2009;20:1170-7.   DOI   ScienceOn
27 Langer B, Langer L. Overlapped flap: a surgical modification for implant fixture installation. Int J Periodontics Restorative Dent 1990;10:208-15.
28 Langer B, Sullivan DY. Osseointegration: its impact on the interrelationship of periodontics and restorative dentistry: Part I. Int J Periodontics Restorative Dent 1989;9:84-105.
29 Orsini M, Orsini G, Benlloch D, Aranda JJ, Lazaro P, Sanz M. Esthetic and dimensional evaluation of free connective tissue grafts in prosthetically treated patients: a 1-year clinical study. J Periodontol 2004;75:470-7.   DOI   ScienceOn
30 Mormann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness. Revascularization and shrinkage: a one year clinical study. J Periodontol 1981;52:74-80.   DOI
31 Barone R, Clauser C, Grassi R, Merli M, Prato GP. A protocol for maintaining or increasing the width of masticatory mucosa around submerged implants: a 1-year prospective study on 53 patients. Int J Periodontics Restorative Dent 1998;18:377-87.
32 Park JB. Increasing the width of keratinized mucosa around endosseous implant using acellular dermal matrix allograft. Implant Dent 2006;15:275-81.   DOI   ScienceOn