Peri-Implant Soft Tissue Augmentation in an Edentulous Mandible - Dental Online College
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Peri-Implant Soft Tissue Augmentation in an Edentulous Mandible

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Duration:

07:36

Surgeon:

Prof. Dr. Hürzeler

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.

Content of the expert video

Following implant exposure, the keratinised gingiva is extended using free connective tissue grafts. Sling sutures are used to press the grafts firmly onto the tissue of the graft bed.
Following implant exposure, the keratinised gingiva is extended using free connective tissue grafts. Sling sutures are used to press the grafts firmly onto the tissue of the graft bed.
The incision is made along the mucogingival junction; damage to the periosteum must be avoided here.
The incision is made along the mucogingival junction; damage to the periosteum must be avoided here.
The prepared mucosa flap is secured in an apical position.
The prepared mucosa flap is secured in an apical position.
The free gingival (mucosa) graft is taken from the palate and divided into several individual pieces of the required size.
The free gingival (mucosa) graft is taken from the palate and divided into several individual pieces of the required size.
Once bleeding has been staunched using a local anaesthetic, the donor site is covered with tissue adhesive.
Once bleeding has been staunched using a local anaesthetic, the donor site is covered with tissue adhesive.

The expert

Prof. Dr. Markus Hürzeler

Private practice Hürzeler/Zuhr in Munich

  • Practising dentist in the joint practice Hürzeler/Zuhr in Munich
  • 2003 Conferment of degree; adjunct professor by the Albert-Ludwigs University in Freiburg
  • Specialist for periodontology (medical specialist equivalent) according to the Swiss (SSP) and German Association of Periodontology (DGP)
  • Specialist for prosthetics (medical specialist equivalent) according to the German Association for Dental Prosthetics and Materials Science (DGZPW)
  • Professorship at the Albert-Ludwigs University in Freiburg and at the University of Texas in Houston / Texas / USA
  • more »
  • botiss dental Gmbh
  • Henry Schein
  • DZR
  • CAMLOG
  • CLINICAL HOUSE EUROPE
  • Komet/Gebr. Brasseler GmbH &Co KG
  • DSI DentaScience Institute®
  • Kuraray
  • BEGO Implant Systems GmbH & Co. KG
  • Zimmer Dental
  • IDI-PARO
  • IPI München
  • Sirona
  • Align Technology Inc.
  • Mectron
  • Health AG
  • Dentsply Sirona Implants
  • W&H Deutschland GmbH

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The Dental Online College is an online learning platform for dental surgeons and students. This service focuses on providing superior-quality professional training videos in the area of dental medicine that can be called up from an Internet platform. As a professional online training platform, the Dental Online College provides dental surgeons and students with instruction in surgical procedure, demonstrating challenging surgical techniques using easy to understand videos, and including interviews that provide further detail, video presentations, and documentation on performing the procedures in question.

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