A New Technique for Second-Stage Surgery in the Posterior Maxilla to Enhance and Thicken the Keratinized Gingiva—A Case Report

Figure 1. X-ray of initial situation before removal of implant in region 24.

Figure 2. Augmentation and implant placement in region 24 and 26.

Figure 3. Clinical situation after removal of implant in region 24, hard tissue augmentation, and implant placement in region 24 and 26 with coronal displacement of the mucogingival junction.

Figure 4 . Palatal shifted incision with a distance of 4 mm to the mucogingival line.

Figure 5. Split-thickness flap for plasty of the vestibule.

Figure 6. U-shaped incision for uncovering of the implants.

Figure 7. Modified roll flap to thicken the buccal tissue.

Figure 8. Installing of the wide-body healing abutments.

Figure 9. Stabilization of the flap to the buccal periosteum with horizontal mattress sutures with existing soft tissue defect between the implants.

Figure 10. Fixation of the soft-tissue grafts between the implants and distal of implant in region 26.

Figure 11. Uneventful wound healing and perfect integration of the grafts. Figure 12. Situation before prosthodontic reconstruction with stable soft tissue conditions.

Figure 13. Delivery of the all-ceramic FDP luted on all-ceramic abutments luted on titanium bases. Figure 14. X-ray after delivery of the FDP.

12-month follow-up with stabile soft-tissue conditions.

Step-by-step schematic of the clinical protocol. (a) MJ indicates mucogingival junction. (b) I, incision line. (c) MF, mucosal flap. (d) IR, Incision for roll flap. (e) CS, cover screw; RF, roll flap. (f) HA, healing abutment; RF, roll flap. (g) SS, single suture; MS, mattress suture. (h) TFGG, thick free gingival graft. (i) Grafts in situ.