In order to increase the amount of keratinized gingiva around two implants, Prof. Hürzeler (Munich) performs the placement of a free gingival graft in the third quadrant. During the surgery, also the second implant in the molar region is exposed. To begin with, the graft bed in the implant area needs to be created. For this reason, a mucosal flap is prepared and underlying connective tissue thoroughly removed.
Once the excision of mobile tissue remnants is completed, the flap is fixed apically to the periosteum with microsurgical sutures. As a result, the recipient area is fully exposed and ready for the graft placement. In a next step, the second implant is exposed, its cover screw removed and a healing abutment placed. Adjacent connective tissue is fixed closely around the implant neck with microsurgical sutures.
Now, the free gingival graft is harvested from the palate. It should have an even thickness of 1 to 1.5 mm. Before the free gingival graft is transferred and adapted to the prepared tissue bed, fat and connective tissue have to be removed. The palatal wound is covered with histoacryl glue and a splint in order to facilitate the healing process. The obtained graft is fixed with Gore-Tex sutures and moderately pressed onto its recipient bed.
Moderate pressure and the stabilization of the free gingival graft in its bed are important for the growth of blood vessels into the transplanted tissue, hence its survival and the success of this surgical procedure.