In this video, Professor Hannes Wachtel (Munich) performs peri-implant soft tissue augmentation in region 24. He places a connective tissue graft in the area of an implant that had been inserted five weeks before. The initial situation around the implant shows an immense loss of peri-implant gingival tissue. The goal of this surgical procedure is both prosthetic and aesthetic improvement.
First the harvesting of the connective tissue graft is conducted: Following a palatal incision vertically to the surface, the scalpel is guided at an angle so that a graft of even thickness (ideally 1-1.5 mm) can be taken from the palate. Primary wound closure is performed placing continuous crossing sutures using non-resorbable suturing material.
Dr. Wachtel then prepares the recipient bed for the insertion of the connective tissue graft by creating a split thickness flap in the implant area. The initial incision in the keratinized gingiva in region 24 is extended into the sulcus of the adjacent teeth. The periosteum is not included and stays attached to the bone. Once the graft has been inserted and positioned in the recipient bed it is attached securely using microsurgical sutures in order to prevent movement during the healing process. Primary wound closure is performed applying double-layer sutures, with slight correction using additional microsurgical sutures to establish proper placement at the edges of the wound. For better control the sutures are usually placed from the palatal towards the buccal flap