Creating Attached gingiva in a full arch lower jaw

254 Rating(s).


Posted on By Howard Gluckman In Soft Tissue Enhancement

The lower jaw has one major problem. ATTACHED GINGIVA. The minute the teeth are removed the gingiva shrinks as a result we end up with very limited attached gingiva. When placing implants we often use Full thickness flaps and simply suture the flaps back into position around the abutments. As a result the attached gingiva shrinks even further leaving a situation that has potential dire consequences for the future. Lack of attached gingiva and muscle pull our contributors two periimplantitis.
Showing below is a very simple technique of vestibuloplasty prior to implant placement which allows the creation of a thick band of attached gingiva. an apically reposition flap is prepared split thickness and then sutured with periosteal sutures at an apical level. The initial incision is made in the attached gingiva thus only allowing keratinised epithelium to grow in.




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15 Comments

6 months post op shows the outstanding thick attached gingiva that was achieved in one procedure. If one wants to reduce bone one can still do this procedure however the periost can be raised and then bone cut away and then the periost alone can be sutured back to cover the bone. There is no problem leaving the bone open and allowed to heal by secondary intention. If this is the case I would place the implants a little deeper 2mm below the crest just in case there is some bone loss.

14 days post op healing
6 months post op


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This so important and critical for our management of soft tissue especially around implants and full arch cases at uncovering. Thanks my friend for sharing this case. Regards Mo


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A technique that is totally und3rused in the lower jaw. Could not agree more Mo


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nice case.do you mean the initial incision for split thickness must be made in keratinized ginigvae or there will have no attached gingivae form later?


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The incision must split the attached gingiva so that only keratinised mucosa can fill the void.


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I used to pay attention to the bone rather to soft tissue in my earlier carrier and now I see the results of my mistakes. We all learn on our mistakes. Thank you for sharing. Gregory


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Great insight Mark. We need to pay attention to both equally.


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Truly right my friend Howie! Fixed tissue, keratinized or non-fully keratinized, but fixed is what we need around our implants. We have to spread the issue that bone can be exposed and covered by 2nd intention as a usefull tool to gain, vestible deepness and stable tissues around implants. Thanks for posting. Regards Jorge


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totally agree it is a non issue. thanks for the reply


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would you consider gintuit?


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Gintuit would work here...if you can get it still.


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Hi sorry I don't know what gintuit is?


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Do you have a video that shows this technique?


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sorry not currently but will make one


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Howie the GREAT!!! Thnx Mo


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