Periimplant Soft Tissue Enhancement - a two case comparison

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Posted on By Matko Oguic In Soft Tissue Enhancement

A well-designed systematic review from 2014* suggests the use of autogenous grafts (SubepithelialCTG/FGG) as gold standard for soft tissue volume increase. No soft tissue substitute materials can be recommended for this procedure. Soft tissue augmentation in fully edentulous patients were excluded.
In prospective clinical investigation, prof. Urban has achieved the same results using “combination graft technique”(CGT) as they had with vestibuloplasty in combination with FGGs.
CGT - is combining an apically placed autogenous strip gingival graft with a xenogeneic collagen matrix (XCM; Mucograft, Geistlich).
The gingival strip may be considered as key factor in achieving lower graft contraction then using XCM alone. It can prevent mucosal rebound together with apical stabilisation and potential to keratinise in the initial healing faze.
As the main role of CMX is stabilisation of a blood clot and a scaffold provider, we assumed that the PRF may have much better healing potential.

In our cases (Dr.Keca & Dr.Oguic)you can notice extremely nice healing in initial faze enhanced with PRF but the final result is not as expected. There were about 1 mm of keratinised tissue buccal after vestibuloplasty(case 2 - shown in comments). The exposed periosteum needs to be covered with graft because a nearly complete relapse is to be expected during secondary healing in lower jaw.

In the another case(case 1) you can see vestibuloplasty alone with mucogingival strip with no initial keratinised tissue around implants. Results are more satisfying.

Combination of PRF and MGstrip my be a win-win combination.

Dr.Keca & Dr. Oguic (Team Croatia)

Case 1 - Inital situation
Case 1 - Vestibuloplasty

Case 1 - Gingival Strip Graft taken from the palate
Case 1 - Final Surgery


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8 Comments

Case 2 - Initial
Case 2 - Surgery


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Case 2 - Postoperative
Case 2 - Healing after 1&2 weeks


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Case 2- 1 month result
Case 2 - result after 2 months


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Matko; Great work and very much displaying the CRITICAL importance of 2nd Stage implant surgery which is often overlooked. Great skill, precision and documentation. Welcome to XP Forum. My only question is amongst the 3 below which one do you prefer;
1. Strip Graft Urban
2. PRF Fibrin
3. Full FGG
Thanks Dr. Salama


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Dear Dr. Salama, thanks for a comment. After trying some different techniques, we came to a conclusion that the best results are achieved with a Strip Graft as described by prof. Urban (even though without CMX, because we’ve never used it) as it seems that the strip of gingiva can prevent mucosal rebound together with apical stabilisation and the potential to keratinise in the initial healing phase, and what is also important, the donor site on the palate heals quite nicely and it is more comfortable for the patient then than taking a big gingival graft to cover the exposed periosteum.
Combination of PRF and Strip Gingival Graft may be a win-win combination since a-prf may have much better healing potential, and that’s the next technique we’re going to try.


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Monika and Matko,it seems that gingiva strip plus PRF could be a winner combination. Very nice explained!
Both of you think a lot about every procedure: this is a way to go! Not ”Monkey see, monkey do” attitude.
Well done, documented and presented!
doktorica


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Thanks Doc! You have set a good example for us. That's the way to go :)


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Really beautiful management. I truly believe this is an often misunderstood and poorly appreciated part of implant rehabilitations....thanks for sharing Dr. Salama


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BTI
Hu-Friedy