In the following video, Prof. Dr. Hannes Wachtel (Munich) aims to remove an aesthetically unpleasant discoloring of the gingiva due to an amalgam tattoo in the maxillary anterior region. The amalgam tattoo is the consequence of an apicoectomy (root end surgery) performed with amalgam several years ago. Initially a subepithelial connective tissue graft is taken from the palatal region. The palatal wound is closed with a running suture, and a splint is inserted to support the initial healing period.

After a split thickness flap is prepared in the area of the affected gingiva, the underlying discolored tissue is removed. The graft obtained from the palate is then placed into the prepared pocket and attached to the buccal flap with microsurgical sutures. The flap is replaced on top, and since the patient is a smoker the wound has to be closed meticulously. Further plastic surgery is planned in this area.