A Novel “Microscrew With Tie-Down Sutures” Technique for FGG Anchorage: A Case Report
The most challenging and time-consuming step in the free gingival graft (FGG) for keratinized mucosa augmentation is the compression suture anchoring the FGG to the periosteum. This article proposed a novel “microscrew with tie-down sutures” technique to anchor the FGG to the recipient site without the traditional trans-periosteum suture. This patient’s keratinized mucosa width (KMW) around the healing abutments of teeth #29 and #30 was less than 1 mm. After an apically positioned flap (AFP) was prepared, 2 microscrews were placed at the buccal plate of the alveolar ridge bone, which is the coronal margin of the AFP. Then, the sutures winded between the microscrews and the healing abutments to anchor the FGG. In conclusion, the “microscrew with tie-down sutures” technique offers a feasible and straightforward alternative for the trans-periosteum compression suture, mainly when the periosteum is fragile, thin, or injured.
(a) Clinical photograph taken after implantation with non-submerged healing for 3 months, showing KM insufficiency of the implant of teeth 29 and 30. (b) Radiograph examination taken after implantation with nonsubmerged healing for 3 months (the loosening healing abutment of the implant of tooth 30 was taken off before taking X-ray examination).
(a) Apically positioned flap. (b) Two microscrews were placed on the buccal plate, and the healing abutments were screwed on the implants of teeth 29, 30, and 31.
(a–c) Surgical process of FGG harvest from the right maxillary palatine. (d–f) Width, length, and thickness of the FGG measured by the periodontal probe.
(a) FGG was initially placed on the recipient site by 2 single interrupted sutures on the mesial and distal periosteal bed. (b) 4-0 suture was used to tie down the graft by crossing the healing abutments and the microscrews to immobilize the graft.
(a) Clinical photograph of the recipient site taken on day 14 after operation. (b) FGG survived, and the edge of the wound at the recipient site was still red and swollen on day 14 after operation. (c) Clinical photograph of the donor site taken on day 14 after operation. (d) Clinical photograph of the recipient site taken 1 month after operation. (e) KM around the implant-supported crown was stable and healthy after final restoration at the 1-year follow-up. (f) Radiograph examination taken after final restoration at the 1-year follow-up.
(a) Schematic of the traditional FGG suturing technique. (b) Schematic of the “microscrew with tie-down sutures” technique to immobilize the graft.
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