Stage 2 Uncovering is VERY Critical!!!

228 Rating(s).


Posted on By Maurice Salama In Soft Tissue Enhancement

Patient presents for uncovering following bone graft and implant placement. Lack of Ridge width and KT is significant as well as an alteration of MGJ and vestibular depth. Incision is split thickness wat to the palatal aspect and labially/apically repositioned to re-establish KT and Vestibular depth. A significant change utilizing a common perio procedure. Thoughts and comments welcome. Dr. Salama

Split Flap from palate
Preop Clinical

Supra-periosteal dissection
Sutures apically repositioned


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17 Comments

How many would do FGG instead? Dr. S


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I would do the same in a case like this. It seems that you do have the minimum 2mm of soft tissue and more than 3mm of hard tissue buccally. All u need is some more keratinised epithelium and u should be fine with your surgery.


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Absolutely agree with your treatment! We all should be veeeery careful when using punches!! KT is the seatbelt of our implants!! You would never let your kids travel without it, rigth? Same w/ implants!! Hehehe

Looking forward to seeing you in Florida!


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Hi Maurice, You are dead right. I would have done Free Gingival Graft :) Don't like to leave so much bone exposed around implants. Check up the new post Regards!


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Andoni; no bone left exposed.... All split partial thickness.


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very nice, you made it look very easy as usual. Could you please walk me through the apical positioning suturing technique please? Thanks


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Yaarob; We anchor the suture in the periosteum below the MGJ on the labial aspect at the base of the vestibule and then engage the top of the pedicle , this "pulls" the graft into position and keeps it from drifitng back up over the healing abutments. We teach this during our Soft Tissue Mastership HANDS-ON courses. regards Dr. Salama


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Thanks a lot


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I agree with your treatment!!!


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Thank you. "Many roads lead to Rome", this is one dependable procedure in my tool box. Dr. Salama


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I love how clean your split thickness is ,not an easy angle to start it from that palataly ... any tips on how to get it done? Bendable blades ? or just scalpal and tweezers and working from other side of mouth? Do you release the apical periosteum in order to allow `flatter` adaptation of the flap? since the vertical releasing dont seem too adapted...at least in picture.. nice result ! tnx aryeh


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Aryeh; Yes, difficult angle indeed. Either bendable microblades or enter from opposite side of the mouth as you said. Must release and split flap into vestibule to allow proper apical repositioning otherwise the tendency is for rebound and bunching of the tissue. regards Dr. Salama


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Absolutelly agree with you, Mo. This case needs kg around and a deep vestible, both objectives achieved at the same time. I would, also , do Snjezana Robin Hood technique, using a palatall ctg to thicken vestible...Did you think about that? You thought was not necessary? What is your approach in this case? Regards, Jorge


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Jorge, in hindsight I think the additional CTG woykdbhave helped add bulk and thickness. Regards Mo


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I agree with Jorge also. A little addional CTG (or FGG)is important for form, function and longevity.

Pre and post CTG
CTG prior to placement


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Chuck; Definitely, on my case if you look at post op, the tissue around implants appears THiCK enough, it is the PONTIC site where additional CTG would have been helpful. Perhaps the "Collagen Ball Technique" just shown on Dentalxp THIS WEEK would have sufficed? regards Mo


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I look forward to seeing the ball technique. I am sure it will minimally invasive as much as I am sure it will not be as effective as Autogenous tissue. Give and take in all we do.

Pre FGG
Post FGG


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KLS Martin
Align / iTero