J Korean Assoc Oral Maxillofac Surg.  2020 Dec;46(6):417-421. 10.5125/jkaoms.2020.46.6.417.

Retrospective case series analysis of vestibuloplasty with free gingival graft and titanium mesh around dental implant

• Ku JK
• Leem DH

• KMID: 2510016
• DOI: http://doi.org/10.5125/jkaoms.2020.46.6.417

Abstract

Objectives
The purpose of this paper is to introduce an effective technique to easily obtain adequate amounts of keratinized gingiva and vestibular depth.
Materials and Methods
Free gingiva (vertical height 10 mm) was harvested on the palatal mucosa and a partial thickness flap was elevated on the recipient site with same width as the free gingiva graft. After a conventional suture, a titanium mesh covered the graft and was fixed with miniscrews. Titanium mesh was removed 4.1±2.5 weeks after surgery. The amount of keratinized gingiva and vestibular depth was measured at the final follow-up.
Results
Nine patients (males 4, females 5; 53.9±14.1 years) who underwent bone graft surgery before vestibuloplasty were included. No free gingival graft failure or complications were encountered in any of the patients. The relapse rate for vestibular depth (23.3%) was lower than that for keratinized gingiva (48.3%) after 34.4±14.4 months (P=0.010).
Conclusion
Vestibuloplasty with a free gingival graft using titanium mesh could be achieved with an acceptable amount of keratinized gingiva and an appropriate vestibular depth around dental implant.

Keyword

Dental implant; Tissue graft; Titanium; Vestibuloplasty

Figure

• 

  Fig. 1 Lack of keratinized gingiva and vestibular depth due to bone graft and implant surgery. A. Patient #1. B. Patient #2. C. Patient #4.

• 

  Fig. 2 Vestibuloplasty with free gingival graft and titanium mesh. A. Suturing of the graft onto the recipient periosteum. B. Adaptation of titanium mesh with bone screws. C. Overgrowth of muscular fiber covering the titanium mesh 4.5 weeks postoperative. D. Removal of the titanium mesh and screws, and surplus soft tissue 4.5 weeks postoperative.

• 

  Fig. 3 Follow-up after removal of the titanium mesh. A. Incomplete gingival remodeling 5.5 weeks postoperative. B. Sufficient amount of keratinized gingiva and vestibular depth 10 weeks postoperative.

Reference

References

1. Schwartz-Arad D, Chaushu G. 1997; Placement of implants into fresh extraction sites: 4 to 7 years retrospective evaluation of 95 immediate implants. J Periodontol. 68:1110–6. https://doi.org/10.1902/jop.1997.68.11.1110 . DOI: 10.1902/jop.1997.68.11.1110. PMID: 9407405.

2. Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE. 2016; The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study. J Clin Periodontol. 43:305–10. https://doi.org/10.1111/jcpe.12504 . DOI: 10.1111/jcpe.12504. PMID: 26718112.

3. Schmitt CM, Tudor C, Kiener K, Wehrhan F, Schmitt J, Eitner S, et al. 2013; Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol. 84:914–23. https://doi.org/10.1902/jop.2012.120084 . DOI: 10.1902/jop.2012.120084. PMID: 23030237.

4. Bohannan HM. 1962; Studies in the alteration of vestibular depth I. Complete denudation. J Periodontol. 33:120–8.

5. Wang RR, Fenton A. 1996; Titanium for prosthodontic applications: a review of the literature. Quintessence Int. 27:401–8. PMID: 8941834.

6. Ku JK, Leem DH. 2019; Vestibuloplasty covering titanium mesh with grafted free gingiva on anterior mandible: technical report and rationale. J Korean Assoc Oral Maxillofac Surg. 45:369–73. https://doi.org/10.5125/jkaoms.2019.45.6.369 . DOI: 10.5125/jkaoms.2019.45.6.369. PMID: 31966983. PMCID: PMC6955429.

7. Egli U, Vollmer WH, Rateitschak KH. 1975; Follow-up studies of free gingival grafts. J Clin Periodontol. 2:98–104. https://doi.org/10.1111/j.1600-051x.1975.tb01730.x . DOI: 10.1111/j.1600-051x.1975.tb01730.x. PMID: 1055730.

8. Lim HC, An SC, Lee DW. 2018; A retrospective comparison of three modalities for vestibuloplasty in the posterior mandible: apically positioned flap only vs. free gingival graft vs. collagen matrix. Clin Oral Investig. 22:2121–8. https://doi.org/10.1007/s00784-017-2320-y . DOI: 10.1007/s00784-017-2320-y. PMID: 29275490.

9. Thoma DS, Benić GI, Zwahlen M, Hämmerle CH, Jung RE. 2009; A systematic review assessing soft tissue augmentation techniques. Clin Oral Implants Res. 20 Suppl 4:146–65. https://doi.org/10.1111/j.1600-0501.2009.01784.x . DOI: 10.1111/j.1600-0501.2009.01784.x. PMID: 19663961.

10. Elkhaweldi A, Rincon Soler C, Cayarga R, Suzuki T, Kaufman Z. 2015; Various techniques to increase keratinized tissue for implant supported overdentures: retrospective case series. Int J Dent. 2015:104903. https://doi.org/10.1155/2015/104903 . DOI: 10.1155/2015/104903. PMID: 26124833. PMCID: PMC4466381.