Periimplant Soft Tissue Enhancement - a two case comparison
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)