Increase of the Keratinised Mucosa width adjacent on an implant with a Mixed Connective Tissue – Epithelial graft.
The
patient is referred for the creating of a zone of keratinised mucosa, buccal of
the implant crown #46. The aim of the
intervention is to create a zone of keratinised mucosa of about 2mm buccal of
the implant, which will improve patient’s ability for the efficient practice of
oral hygiene and maintain tissue health and stability in the long term.
Due
to the think tissues buccal of the implant, but also to the fact that much of
the tissues to be augmented is in close proximity with the implant abutment (thus
deprived of a vascular bed on periosteum), we have selected a Hybrid Epithelial
– Connective Tissue graft as intervention of choice.
After
removal of the crown and placement of a healing abutment, a split-thickness, apically
repositioned flap buccal of the implant is executed. The buccal side of the flap is fixed in an
apical position with lateral sutures, exposing the periosteum. A mixed connective tissue-epithelial graft is
harvested from the palate and fixed on the buccal flap, with the connective
tissue component sutured against the flap, while the epithelial component is
sticking out on top of the apically repositioned flap. The grated area is stabilised with mattress
and single interrupted sutures and the site is left to heal with the healing abutment
for 6 weeks, after which the crown is being placed back.
The
mixed CT-epithelial tissue graft allows for better vascularisation of the
graft, which is now supported by the sizeable connective tissue attached to the
split-thickness pocket and not only from the periosteum of the recipient
site. This graft can allow for the predictable
creation of a keratinized zone of adequate width, while mildly augmenting the volume
as well. Stabilisation of the wound
while avoiding over-compression is one of the challenges of the suturing
technique.
The
patient is instructed Chlorexidine Mouthrinse for 4 weeks and is followed up at
weeks 1,4 and 6 at which time the healing is adequate for the replacement of
the implant crown. Oral Hygiene is practiced with medium hardness manual
toothbrush and interdental brushes.