An Alternative Approach for Augmenting the Anterior Maxilla Using Autogenous Free Gingival Bone Graft for Implant Retained Prosthesis
Numerous factors may keep surgeons from placing implants in the anterior maxilla in order to avoid suboptimal restorative outcomes. This paper describes a technique of an autogenous-free gingival−bone block graft, which allows bone and gingival augmentation and a primary seal to be achieved simultaneously. Additionally, it describes a technique for achieving primary soft tissue closure of maxillary extraction sockets using a rotated pedicle palatal connective tissue flap.
Figure 1. Preoperative frontal view in maximum habitual intercuspidation. Figure 2. Preoperative occlusal view of the ridge and the residual roots for teeth #6 and #9. Figure 3. After flap reflection showing thin ridge. Central incisor was extracted atraumatically due to vertical line fracture. Figure 4. An 8 mm trephine bur was used to harvest a bone-tissue cylinder from the tuberosity that was compatible with the alveolar defect of the site #9. Figure 5. The free gingival bone graft is positioned in the defected of site #6. Figure 6. Subepithelial connective tissue pedicle flap was harvested from the palate and rotated to close the surgical wound over site #6.
Figure 7 . Tension-free primary wound closure. Figure 8. Six month postop occlusal view. Note the width and healthiness of the soft tissues. Figure 9. Second-stage surgery conducted 6 months postop. Healing caps placed for implants #6 and #9. Figure 10. Acrylic provisional prosthesis placed 1 week after second-stage surgery. Figure 11. Preparable titanium abutment in position. Note the healthy tissues for the peri-implant site #9 and the morphology attained by soft tissue management for site #8. Figure 12. Preparable titanium abutment in position. Note the healthy tissues for the peri-implant site #9. Figure 13. Frontal view of final porcelain-fused to metal prosthesis 12 months postop. Figure 14. Patient's smile showing the aesthetic result.
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