Free Gingival Graft to salvage Implants

112 Rating(s).

Posted on By R. Terry Councill In Periodontics

64-year-old female presents in good health. Inherited case with three different implant types. Patient desires restoration. In position number 12, Quantum implant with tapable abutment. In position number 14, Implant One with screw retained abutment, in position number 15, Bio-Horizons external implant with screw retained abutment. There is zero keratinized tissue on the buccal aspect and poor prognosis. A large free gingival graft, measuring 33 mm, was taken from the palate and sutured on the buccal aspect to provide an adequate zone of acceptable tissue. The tapabale abutment in position number 12, had to be over prepared to provide for path of insertion. Provided for a screw retained the prosthesis in position number 14 and 15 and used temporary cement for position number 12. This will allow for retrieveability and maintenance. Comments requested!

Pre.op and CTG
Surgical Post.Op

Post.op 3 months

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Terry well managed. This case without keratinized gingiva would atract many problems.
Latelly I´m screwing this FGG to bone and I´m having very nice results. Suturing takes longer IMHO.
Regards and thanks for posting.
I´m posting also a case of keratinized gingiva...


Once again congratulations for your work. I think KG has a very important role in the long term maintenance of dental implants. The FGG has still some important indications, and this is one of them. Your results are very good and I think you gave your patient a wonderful service, specially to aloud him to avoid future problems in her maintenance therapy. A key point in this type of procedures, as you know, is the stability of the graft, and you managed it perfectly.
Thanks for sharing.
Warm regards and see you in Brazil in December.


Terry; LOVE what you did here surgically. You managed it very well. Another option could have been a split thickness flap apically repositioned onto the labial aspect. What I do NOT like here is the restoration and artificial gingiva and bulk. I have seen here in my own office that this is almost impossible to clean and eventually leads to peri-implant mocositis. A cleansable area for hygiene and irrigators is critical. Also, it appears to be a cementable prosthesis which is more challenging. GREAT post. See you in Brazil. regards Dr. S


Thanks guys for your positive comments and constructive criticism. We did spend a while with the patient instructing hygiene, and you are right Dr. S, it was challenging. Perhaps a re-contour is in order. The prosthesis is screw retained in the posterior implants and cement retained in the most anterior implant. The most anterior implant was a tapped in abutment. Never seen that before.


Here is a similar case...FGG at uncovering with split flap and APF did just 20 minutes inspired me. Thanks Dr. S

Before uncovering
After FGG


And another from a few weeks back...

FGG sutured



Bed preparation
3 weeks healing


You know who inspired who. I'm honored to be your student. Thanks for the encouragement.


Great soft tissue management from both inspirational XPerts. I especially like the last dr. Maurice Salama case because the care about soft tissue is taken prior to implant exposure. Is it done before implant placement or during osseointegration, Maurice?
Thank you for sharing, Terry
Best regards