Page 145 - 7. FINAL draft Compendium 2019 2020_22072022

FULL GINGIVA GRAFTING ON MAXILLARY ANTERIOR RIDGE PRIOR TO PLACEMENT OF
IMPLANT SUPPORTED BRIDGE – CASE REPORT

Norhayati A, Ahmad KTZ@Z

Introduction: Insufficient keratinized gingival tissue can be increased surgically by free
gingival grafting (FGG). The presence or reconstruction of keratinized tissue (KT) around
the implant can facilitate restorative procedure and allow the maintenance of an oral
hygiene routine without irritation or discomfort to the patient. Case report: A 21-year-old
Chinese male referred to our unit for gingival augmentation prior to prosthesis placement
to replace 4 missing upper anterior teeth lost due to motor vehicle accident. He did not
have any medical problems and was not taking any medication. Two implant fixtures were
inserted to retain 4 unit-porcelain bonded metal bridge (PBM) 4 months prior to gingival
augmentation procedure. Intra-orally the area of teeth number 12 until 22 showed lack of
KT, shallow vestibular sulcus and present of multiple scars due to previous laceration
wounds. A preoperative cone-beam computed tomography (CBCT) scan revealed 2-unit
dental implant fixtures in good conditions. At the recipient site (buccal area of teeth 12
until 22), a split thickness flap was done under local anesthesia (LA) using microsurgery
instruments to prepare the bed for FGG. The FGG were harvested from both sides of palatal
area of posterior teeth under LA according to measured sizes. The grafts were sutured onto
recipient bed using 6/0 and 7/0 sutures with simple interrupted and sling techniques. Post-
operative reviews showed uneventful healing. At 3-month post-operative review, it was
noted of a good acceptance of the graft at the recipient site and the increased of thickness
and width. The amount of keratinized tissue around implants may be important for peri-
implant tissue health. Adequate width and healthy peri-implant gingival tissue will enhance
higher success rate and longer survival rate of implant retained prosthesis. Conclusion: The
free gingival graft is an effective and safe treatment in increasing the width of maxillary
keratinized tissue and provide an improvement in maintaining the health of peri-implant
tissues which allows for better oral hygiene performance.

2 place for poster presentation competition at the East Coast Research Day (ECRD) 2019, Kuala Terengganu by CRC
nd
Terengganu.
Dr Norhayati Abas
Unit Pakar Periodontic Specialist Unit
Paya Besar Dental Clinic
Kuantan Pahang

Dr Ahmad Kamal Tarmizi bin Zamli @ Zamdi
Department of Oral and Maxillofacial Surgery
Tengku Ampuan Afzan Hospital
Kuantan Pahang

123