References

Berglundh T, Armitage G, Araujo MG Periimplant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018; 89:(Suppl 1)S313-S318 https://doi.org/10.1002/JPER.17-0739
Caton JG, Armitage G, Berglundh T A new classification scheme for periodontal and periimplant diseases and conditions - Introduction and key changes from the 1999 classification. J Periodontol. 2018; 89:(Suppl 1)S1-S8 https://doi.org/10.1002/JPER.18-0157
Renvert S, Persson GR, Pirih FQ, Camargo PM Peri-implant health, peri-implant mucositis, and peri-implantitis: case definitions and diagnostic considerations. J Periodontol. 2018; 89:(Suppl 1)S304-S312 https://doi.org/10.1002/JPER.17-0588
Monje A, Blasi G Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers. J Periodontol. 2019; 90:445-453 https://doi.org/10.1002/JPER.18-0471
Souza AB, Tormena M, Matarazzo F, Araújo MG The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health. Clin Oral Implants Res. 2016; 27:650-655 https://doi.org/10.1111/clr.12703
Camargo PM, Melnick PR, Kenney EB The use of free gingival grafts for aesthetic purposes. Periodontol 2000. 2001; 27:72-96 https://doi.org/10.1034/j.1600-0757.2001.027001072.x
Sokolovich NA, Shalak OV, Petrova NP Current issues in the management of soft tissues of the oral vestibule before orthodontic treatment. Archivos Venezolanos de Farmacología y Terapéutica. 2020; 39:205-210
Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study. J Clin Periodontol. 2016; 43:305-310 https://doi.org/10.1111/jcpe.12504
Tavelli L, Barootchi S, Avila-Ortiz G Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis. J Periodontol. 2021; 92:21-44 https://doi.org/10.1002/JPER.19-0716
Avila-Ortiz G, Gonzalez-Martin O, Couso-Queiruga E, Wang HL The peri-implant phenotype. J Periodontol. 2020; 91:283-288 https://doi.org/10.1002/JPER.19-0566

An apically positioned flap and free gingival graft around an implant

From Volume 51, Issue 7, July 2024 | Pages 476-478

Authors

Matthew K Morris

BSc, BDS, PGCME, MSc, MPerio, MFDS (RCS Ed), FRCDC

Specialist in Periodontics (Canada and UK)

Articles by Matthew K Morris

Email Matthew K Morris

Debora Matthews

BSc, DDS, Dip. Perio, MSc

Professor, Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada

Articles by Debora Matthews

Richard Bengt Price

BDS, DDS, MS, PhD

Professor, Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada

Articles by Richard Bengt Price

Abstract

Following the ‘2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions,’ hard and soft tissue deficiencies have been debated in the literature with keratinized mucosa at the forefront. In this case report, the present author investigated whether an apically positioned flap and free gingival graft to increase keratinized mucosa and vestibular depth improved oral hygiene and patient comfort around an implant-retained upper complete denture. Using an apically positioned flap in combination with free gingival graft to augment the soft tissues around implants with hard and soft tissue deficiencies, increased both the keratinized mucosa and vestibular depth to correct the soft tissue deficiencies. This case report highlights the importance keratinized mucosa and vestibular depth has at the patient and site level in improving oral hygiene and patient comfort. This case report also supports the growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.

CPD/Clinical Relevance:

This case report supports growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.

Article

Following the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, peri-implant health, disease, conditions and deformities were reviewed.1 It has been reported that following tooth loss, hard and soft tissue deficiencies occur as result of normal healing of the alveolar ridge/process.2 This can compromise the aesthetics and long-term survival of implants, especially as maintenance is compromised. Biofilm on implant surfaces was reported as the main aetiological factor that causes peri-implant mucositis and peri-implantitis.3 Therefore, ensuring the environment is conducive, ensuring optimal oral hygiene (OH) is of utmost importance during implant maintenance for both the patient and clinician. It has been reported that patient brushing discomfort, biofilm accumulation and peri-implant soft tissue inflammation are all increased when the keratinized mucosa (KM) is <2 mm.4,5 The free gingival graft (FGG) is usually an autogenous graft harvested from the palate or tuberosity to increase KM, increase vestibular depth (VD), increase tissue thickness, treat recession, prevent further recession and improve plaque control because tissues are more resistant to physical, chemical and thermal trauma.6

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