In this surgical procedure, Professor Markus Hürzeler (Munich) extends the excessively narrow keratinized gingiva around implants in the posterior area of quadrant IV applying a free gingival graft. First, the graft bed is prepared with great care in order to establish proper healing conditions. The incision at the recipient site is performed vertically along the mucogingival junction. A mucosa flap of even thickness is then prepared, extending into the vestibulum.

The connective tissue that is still attached to the periosteum is circumcised and cut off. Epithelium at the coronal site of the bed and remaining mobile tissue parts that are still attached to the base have to be removed thoroughly in order to prepare a proper graft bed. The thinned mucosa flap is fixed at the existing connective tissue in an apical position with a mattress suture using absorbable suture material.

To obtain a free gingival graft of the required size, the graft bed is measured and the size transferred to the donor region of the palate by placing bleeding points. Following the incision, a free gingival graft is prepared by repeatedly angling the scalpel. Overlapping incision ends facilitate the harvesting of a graft with even thickness. The palatal wound is treated with local anesthesia and a histoacryl glue, finally covered with a dressing plate.

Then, the free gingival graft is applied to the prepared bed. After little adjustments at the wound edges it is fixed to the new base with loop sutures using Gore-Tex material. A stable fixation and steady contact pressure are very important and will result in good adaption of the graft and proper healing in the augmentation area.