Appl. Prof. Dr. Christian Mehl, Munich/Germany, demonstrates the implantation of seven implants in a maxilla and the vestibular gingiva thickening with connective tissue grafts. Four months prior to this surgery, the maxilla was horizontally augmented and a sinus lift was conducted on both sides. The second surgery, shown in the present video, begins with the creation of full thickness flaps to expose the bone. In many places the bone substitute material is still visible; this is often the case for many years.

The implant positions are determined using the drilling template, and pilot drillings are performed in a slightly palatal position. In the posterior area the full length of the implant beds is reached through bone splitting with an osteotome. Once the implants are inserted in a slightly subcrestal position, the bone around the implant shoulders is cautiously reduced to make sure that impression posts and gingiva shaper can closely be adapted to the implant. In order to thicken the gingiva in the vestibule of the anterior region, a connective tissue graft is obtained from both sides of the palatal area.

These transplants are inserted in the vestibule and secured with simple mattress sutures. In some peri-implant areas, more bone substitute material is added to stabilize the implants. Finally, the flaps are fixated on top with double sling sutures. In this case, open gaps between the wound edges are not a problem; they will close gradually through secondary wound healing.