Case report of using partially epithelialized connective tissue graft for peri-implant soft tissue augmentation simultaneously with dental implant placement

Abstract

Objective. To demonstrate clinical option of using partially epithelialized connective tissue graft for periimplant soft tissue augmentation simultaneously with dental implant placement procedure to enhance peri-implant esthetic profile and optimize soft-tissue stability for further prosthetic rehabilitation. Case report. Patient 46 years old patient referred to the dental clinic with complaints regarding condition of mandibular fixed denture, which he was using already for 9 years. Also, patient informed dentist that he wants to improve his chewing ability by restoring edentulous distal regions of mandible with implant-borne fixed dentures. Patient previous denture was gently deattached from mandibular abutment teeth while not altering periodontal conditions of any of them during procedure. All the targeted and periodontal treatment was provided based on clinical need. Tissue level implants were placed at the projection of teeth 4.5-4.6 and 3.6-3.7 due to the conventional implant placement protocol. To compensate soft tissue collapse within the implant placement region it was decided to augment such with partially epithelialized connective tissue graft. Graft was shaped, prepared and partially de-epithelialized to overcome issue of volume excess using standard technique. Partially epithelialized connective tissue graft was positioned carefully with the manner of the epithelial portion covering dental implant part, while connective tissue portion was facing inner surface of separated flap, and was covered by a flap. Modified horizontal mattress sutures were used to secure connective tissue graft at the place while retaining its primarily established positions and guaranteeing tension-free flap closure around installed healing abutments. Results of final rehabilitation outcomes with satisfactory appearance of the soft tissue condition around fixed prosthetic construction were achieved at the end of the treatment.