Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement.
OBJECTIVE
Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the long-term outcome of this grafted gingiva.


METHODS
A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap.


RESULTS
At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue.


CONCLUSIONS
Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.
Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.
Joo-Yeon
0000-0002-4229-5869
JY
Sohn
Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.
Jung-Chul
0000-0002-2041-8047
JC
Park
Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.
Kyoo-Sung
0000-0002-6777-5287
KS
Cho
Department of Periodontology, Research Institute for Periodontal Regeneration, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea.
Chang-Sung
0000-0003-3902-1071
CS
Kim
Free gingival graft; Interpositional onlay graft; Keratinized tissue; Nonsubmerged implant