A New Technique for Increasing Keratinized Tissue Around Dental Implants: The Partially Epithelialized Free Connective Tissue Graft. Retrospective Analysis of a Case Series

Figure 1. (a) Before surgery, the implant had thin tissues, recession, and a high inserting buccal frenulum. (b) Placement of a partially epithelialized free connective tissue graft (PECTG) began by creating a partial thickness incision along the implant's sulcus, following the mucogingival junction. The vestibular mucosa was then separated from the keratinized mucosa. Figure 2. (a) The PECTG is harvested from the palate, at least 2 mm from the gingival margins with a double blade scalpel. The grade of scalpel angulation defines the width of the keratinized part. (b) The parallel superficial incisions. (c) After a slight change of the scalpel's axis towards the teeth axes, the incision can be performed to the final depth to harvest a sufficient connective tissue part. (d) The PECTG after harvesting.

Figure 3. (a) The keratinized portion of the partially epithelialized free connective tissue graft (PECTG) is positioned near the incision line in the envelope that was created at the recipient site. (b) The partially covered PECTG after suturing. Figure 4. (a) Two anterior mandibular PECTGs, 7 days after surgery. (b) At the 7 day appointment, the healing abutments were removed for impression making. (c) The sites, 2 weeks after PECTG surgery with implant abutments. (d) The graft sites, 1 year postoperatively, both implants are surrounded by a zone of keratinized mucosa (KM). Figure 5. (a) PECTG at the time of placement at 2 mandibular implant sites. (b) This magnified view of the same site 15 years later shows that the graft surface is indistinguishable from the local KM surfaces.