The use of free gingival graft to manage mucogingival problems around implants, before and after prosthetic implant rehabilitation

Abstract

Background: Mucogingival problem is defined as a deviation of keratinized tissues and oral mucosa around teeth and implants from normal dimensions, morphology and amount. Two of the main characteristics of this problem are decreased width of soft tissues around implants and lack of width of keratinized tissues. The use of a soft tissue graft is the most common treatment option. Aim/Hypothesis: The aim of this poster is to present the rehabilitation of a mucogingival problem by using a free gingival graft before and after prosthetic implant placement and to outline the advantages and disadvantages of both scenarios. Material and methods: Two clinical cases have been selected in order to represent these two clinical scenarios. In the first case, a female 66 years old patient, two-one-phase implants were placed in the posterior maxilla (#24, #26). The soft tissue regeneration was performed 2 months later in order to improve the amount of keratinized gingiva around these two implants. The second case was a 60 year old female patient in which two implants with intense mucogingival problem existed in the anterior mandible (#32, #34). The soft tissue rehabilitation was performed 3 years after the final prosthesis had been placed. Results: The clinical outcome in the first case is 4-5 mm keratinized tissues around the dental implants providing an adequate amount of soft tissues for a biologically, fuctionally and esthetically acceptable prosthetic result. In the second case the outcome is 7-8 mm keratinized tissues, which is also an acceptable result. Conclusion and clinical implications: It has been shown that the earlier the management of a mucogingival problem, the better the result. The amount of keratinized tissues and the esthetic outcome is much more predictable when free gingival graft is placed before prosthetic restoration due to the possibility of multiple procedures.