Free Gingival Grafting of All on 5 Maxillary Case

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Posted on By Maurice Salama In Soft Tissue Enhancement

A patient presents with crestal bone loss and tissue recession 1 year after Full Arch immediate restoration at another facility. Often neglected in these case types is SOFT TISSUE MANAGEMENT....we decided to perform Free Gingival Grafts and Vestibuloplasty to compensate and protect the implants from further compromise. Thoughts? Dr. Salama

Preop view of tissue recession and lack of KT
Bed preparation and suturing to periosteum to create vestibule

FGG harvested from palate
Combination of tacks and sutures to secure FGG

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Preop and Post op at 3 weeks...

3 weeks healing


What is your experience with these cases holding up over time? How long do you expect the tissue to stay covering the threads before it becomes an issue again? How does the lack of bone affect the longevity of the soft tissue graft? Have you seen any of Dr. Ernesto Lee's SMART technique for bulk grafting of hard tissue and is that a technique that might some day be utilized in these cases?


Bruce; Lot's of questions. I will attempt to answer them.
1. Yes, this THICK, ATTACHED Keratinized Tissue holds up very well over time as does the vestibular extension removing destructive muscle pulls from the marginal gingiva allowing it to best remain in it's position.
2. Not sure about threads being re-exposed over time but in a much better position now to maintain health and hygiene. Thread exposure can be managed with implantoplasty to remove threads and smooth surface for cleansibility.
3. As for the SMART technique from Ernesto Lee, I have not utilized it and it would appear to me not to offer any significant advantage in this specific situation.
regards my friend Mo


Why did you use tacks in this case for graft fixation? Thank you.


Carl; Just to show an additional option to fix grafts...


4 months healing with prosthesis

4 months healing


Still a common issue....sadly


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