FGG before or after
Patient presented to clinic with hx of bone grafting and dental implants placed 8 years ago by post-grad perio.
#20 implant has failed and our plan is to section it from #19 and remove by reverse torque with hand ratchet. No plan for replacement at this time. Extensive vertical defect with only 4-5mm to mental foramen.
#19 and #30 implants also have bone loss and are painful for pt to carry out normal hygiene.
Treatment plan at this time is focused on disease control: Extraction of #18 and 28, sectioning hopeless implant #20 and removal. Bilateral free gingival grafts on mandibular posterior. Lower left will be treated first.
Trying to be efficient with surgical visits, should we...
A) Extract #18 and FGG #19, 20, 21 at the same time and remove #20 at another visit. (Probably my top choice)
B) Remove #20 implant and FGG at time of removal. Extract #18 later.
C) Remove #20 implant and FGG at time of #18 extraction.
This will be my first FGG after Salama's Tissue course. I have been doing quite a few palatal roll flaps on implant exposures and a few localized CTG's using split thickness pouches on implants, but am otherwise new to soft tissue work.
FGG plan consists of preparation of bed from cantilever pontic up to 21 mesial. Suturing of flap to apical with chromic. Sharp dissection of frenum. Harvest of FGG from UL maxilla with collaplug and compression sutures. Pt has RPD to cover harvest site. Suture of graft to bed at lateral and coronal, compression prevent hematoma, periopac over the top.
Any feedback would be welcome. Also if you think I should start with lower right side instead, as FGG is a new procedure to me.