In this surgery Professor Dr. Markus Hürzeler, Munich/Germany, extends the keratinized peri-implant tissue in an edentulous mandible by apically repositioning the vestibular mucosa and inserting a free gingival graft.
The initial situation is an edentulous mandible where several implants had been placed a few months ago, some of them loaded immediately. The goal of this surgery is to extend the keratinized gingiva around the implants through the application of free gingival graft pieces.
A large mucosal graft is taken from the palate, divided into pieces and transferred to the recipient site in the mandible.
For the creation of the recipient bed an incision is performed along the mucogingival junction which is clearly visible when the lip is stretched. A mucosal flap is carefully prepared and thinned; the connective tissue that is still attached to the fixed periosteum has to be cut off. This procedure has to be conducted very cautiously in order to not damage the periosteum. It also has to be conducted very thoroughly to remove the excessive tissue which helps to prevent thick scar tissue from developing. The thinned mucosal flap is then placed and immobilized in an apical position using absorbable suture material. In this case, a widely extended graft bed is created and needs to be covered with a free gingival graft.
A relatively large graft of even thickness is sharply dissected from the palate. The palatal wound is treated with local anesthesia and Histoacryl glue. The harvested mucosal graft is divided into individual pieces that are positioned and adapted in the prepared graft bed. They are sutured to the new base with loop sutures using Gore-Tex material. The immobilization of the graft and steady contact pressure to the base are crucial to ensure good adaption of the graft pieces and proper healing in the extensive augmentation area. Finally, the temporary denture is inserted.