Use of Subepithelial Connective Tissue Graft as a Biological Barrier: A Human Clinical and Histologic Case Report
The aim of the present study was to develop a method to study the healing process after gingival grafting and to observe the histologic results after use of the modified edentulous ridge expansion technique. A 47-year-old nonsmoking woman with a noncontributory past medical history affected by edentulism associated with a horizontal alveolar ridge defect was referred to the authors for surgical correction of the deficit to improve implant support and the final esthetics of an implant-borne prosthesis. At the 4-month follow-up visit, a biopsy was performed by a punch technique in the same sites of healing abutment connection. The tissue was elevated from the attached gingival. Clinically, the grafted tissues seemed to be attached to the bone surfaces. The histologic findings revealed dense grafted tissues, providing long-term stability to the area. No ligament or bone, characteristic for periodontal regeneration, were observed. The presence of thick attached keratinized tissue around implants may constitute a protective factor against marginal inflammation or trauma.
Figure 1. An autogenous connective tissue graft was layered over the bony wound. The connective tissue graft, about 1.5 mm thick and 27 mm wide, was harvested from the palate. Figure 2. Integration of the grafted tissue in the surrounding tissues was recorded. Figure 3. The healing donor site was recorded (the donor site was selected from the palate).
Figure 4. Panoramic view from the top: mucosa over connective tissue. The epithelium was slightly thickened and parakeratinized (hematoxylin and eosin [HE] stain, ×4). Figure 5. Border area between the mucosa and subepithelial connective showing the many vessels (HE stain, ×25). Figure 6. Middle part: young tissue with numerous fibroblasts with spindle-shaped nuclei and intense angiogenesis. The connective tissue subjacent to the epithelium was composed of collagen fibers of varying thicknesses, with fusiform cells and many blood vessels. Inflammatory infiltrate was absent. No bone or osteoid were observed (HE stain, ×20). Figure 7. Deep margin: mature connective tissue with fusiform cells and rare blood vessels. Inflammatory infiltrate was absent. No bone or osteoid were observed (HE stain, ×10).
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