Vestibulum deepening and FGG

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Posted on By Pedro Pereira In Soft Tissue Enhancement

This is a case where patient came with an "All-on-4" along with lot of planning and execution issues. Several treatment options where presented but, in the end, it was executed according to patient request within the explained limitations.

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14 Comments

Excellent job! I love this method. Latelly I´m just screwing the FGG on buccal without sutures. Have you tryed? thanks for sharing this excellent presentation.
Regards
Jorge


Reply

Thank you Jorge Campos. Very honoured with your words.
Regarding the technique i've never used the screw fixing method, always seemed to me that the tissue would get too squeezed and that could compromise the survival, but it's only a perception. Nevertheless I recognise that it would be much faster to position and secure the graft, which can make an huge diference in the time that the graft remains away from the recipient bed and inherently it's survival chance. I will try it in a next chance.
Regards,
Pedro Peixoto Pereira


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SO very important and VERY well performed. Thank you for sharing. Dr. Salama


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Thank you Maurice. It's a great honour to receive such words from you.
And yes, I completely agree that it's VERY important, I would risk to say it's a MUST HAVE, to have that tissue around our implants to the long term survival and stability of the treatments.
Regards,
Pedro Peixoto Pereira


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Interesting case and Great skills on display (and also very nice video editing ..)
One question though, woudnt you perfer to harvest the second strip from other side of palate so healing might be better since smaller graft was taken, or you rather have only one harvesting site ,where do u feel there would have been more morbidity?
Obviously you chose to go with the one site only but your thoughts on this interest me if you're willing to share..
Great case again would love to see more of your work
Aryeh


Reply

Hello Aryeh Gellman.
First, let me thank you for your kind words.
Regarding the case, interestingly that was a thought that i've had before and during the surgery.
Nevertheless, I'll share with you my thoughts:
-If I harvest from both sides of palate, I will have smaller donor sites, which will result in a possibly faster healing and inherently less morbidity, but the patient will have nowhere to chew during the healing period.
-On the other side, if I keep my donor site unilateral, I'll have, possibly, more morbidity, but, I'll give the patient the possibility to chew (as far as possible of course) to the other side.
-Recovering the cases I've had before (not all like this one), honestly I've had very small donor sites which the patient reported to be very painful and big donor sites that went uneventful till the complete healing.

Considering this three factors I've decided, after the first harvest, to go with the same side. Luckily, for me and for the patient, the healing period went without big pain complains and the patient, in a spontaneous way, told me that the chewing was more easily done to the opposite side, which confirmed me the hypothesis that I've considered.

Thank you once again and it'll be my pleasure to answer any questions you might have.

Regards,
Pedro Peixoto Pereira


Reply

Great management and video, thank you for sharing!
Literature is in accordance with your observation: pain depends on the graft thickness and the thickness of remaining soft tissue on the bone and not on the size of donor surface.
Best regards
Snjezana


Reply

Hello Snjezana,
Thank you for the kind words.
I completely agree with that observation. If you manage to keep a good thickness of remaining tissue the blood supply will be better and the healing will occur much faster and with far less pain.
Best regards,
Pedro Peixoto Pereira


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Very nice case. This situation is very common. How do you handle buccal dehiscences/exposed threads?


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Hello Joseph Zona,

This particular situation was a very sensitive one. My initial goal was to take all the implants out and start all over again, but the patient refused. That decision was based on the overall bad 3d position of the implants and the possibility for a good prosthesis profile.
Regarding your question, when there are dehiscences I try to reverse them with a CTG or a de-epithelialized FGG.
When there are exposed threads it'll depend on the extension of the situation. In initial situations where there are keratinised tissue I try a GBR. When there is a big extension I evaluate the possibility of explantation, but I tend to evaluate every case on its own and keep the patient desires on mind.

Best regards,
Pedro Peixoto Pereira


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Got it...Thanks for reply


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beautiful case and presentation. how thick ideally do you harvest the graft?


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Hello Edward Shapiro,

I try to keep the graft between 1 and 2mm. In this big grafts sometimes it's difficult to achieve a homogeneous thickness due to anatomical limitations (palatal shape, tissue thickness, patient related limitations, etc.)
Nevertheless you can probe the lamina propia and use that measure as a guide through the graft delimitation.

Best Regards,
Pedro Peixoto Pereira


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Wonderful work here and so critical to success. Maurice


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