Prosthetic Rehabilitation in Older Adult with Free Gingival Graft: Case Report
Abstract
Aim: The aim of the present study was to perform the clinical evaluation of the thickness of the soft tissue around dental implants using a free gingival graft obtained from the palate.
Background: Rehabilitation in elderly patients improves physiological functions and quality of life, and when this rehabilitation involves a surgical stage, it becomes a challenge, even for more experienced surgeons.
Methods: a 64-year-old, white, female patient with a complaint of difficulty chewing and discomfort stemming from her dental status. Rehabilitation was proposed involving a multidisciplinary approach to reestablish esthetics, function and wellbeing. For such, 4.1 Bone Level Tapered® implants were installed. During the presurgical preparation, a free gingival graft was planned to increase the gingival area using the Miller technique. After establishing the suitability of the oral environment, impressions were made in alginate for the fabrication of an acrylic surgical stent to protect the donor site on the hard palate and minimize the morbidity of the surgical intervention.
Conclusion: In the case reported, the increase in the gingival tissue using a free gingival graft provided satisfactory peri-implant health in an older patient throughout annual follow-up for 15 years.
References
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2. Camargo PM, Melnick PR, Kenney EB. O uso de enxertos gengivais livres com objetivos estéticos. In: Nowzari H. Terapia Periodontal Estética. Periodontologia 2000, n.2, 72-96. Santos: São Paulo, 2003.
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5. Lorenzana, E. R., & Allen, E. P. (2000). The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. International Journal of Periodontics and Restorative Dentistry, 20(3), 297-306.
6. Davenport IB. The American Dental Club of Paris. Meetings of December 1902 and January and March 1903. Dental Cosmos 1904; 46: 39-46.
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8. Popova C BT. Free Gingival Autograft For Augmentation Of Keratinized Tissue And Stabilization Of Gingival Recessions. In: Journal of IMAB- Annual Proceeding (Scientific Papers) [Internet]. Sofia- Bulgaria: Department of Periodontology Faculty of Dental Medicine, Medical University - Sofia, Bulgaria; 2008 [cited 2019 Jun 16]. p. 7. Available from: https://www.journal-imab-bg.org/statii-08/vol08_2_19-25str.pdf
9. Agudio G, Pini Prato G, Cortellini P, Parma S. Gingival lesions caused by improper oral hygiene measures. Int J Periodontics Restorative Dent [Internet]. 1987 [cited 2019 Jun 16];7(1):52–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3471735
10. Hall WB. The Current Status of Mucogingival Problems and Their Therapy. J Periodontol [Internet]. 1981 Sep [cited 2019 Jun 16];52(9):569–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6169820
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12. Sangnes G, Gjermo P. Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures. Community Dent Oral Epidemiol [Internet]. 1976 Mar [cited 2019 Jun 16];4(2):77–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1062255
13. Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol 2000 [Internet]. 2001 [cited 2019 Jun 17];27:72–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11551301
14. Bjorn H. Free transplantation of gingiva propria. Swed Dent J. 1963;nov(22):684–9.
15. Nabers JM. Free gingival grafts. Periodontics [Internet]. [cited 2019 Jun 18];4(5):243–5 1966. Available from: ttp://www.ncbi.nlm.nih.gov/pubmed/5223124
16. Shah R, Thomas R, Mehta S. Recent modifications of free gingival graft: A case series. [cited 2019 Jun 18];6:425. Available from: http://www.contempclindent.org
17. John V, Langer L, Rasperini G, Kim DM, Neiva R GH, Dibart S, Sanz M SE. Periodontal soft tissue non-root coverage procedures: practical applications from the AAP Regeneration Workshop: enhancing periodontal health through regenerative approaches. Clin Adv Periodont. 2015;5(1):11–20.
18. Scheyer ET, Sanz M, Dibart S, Greenwell H, John V, Kim DM, et al. Periodontal Soft Tissue Non–Root Coverage Procedures: A Consensus Report From the AAP Regeneration Workshop. J Periodontol [Internet]. 2015 Feb [cited 2019 Jun 17];86(2-s):S73–6. Available from: http://doi.wiley.com/10.1902/jop.2015.140377
19. Ashurko I.P et al., Keratinized Attached Gingiva around Dental Implants: The Role, Structure, Increasing Techniques., Indo Am. J. P. Sci, 2018; 05(10).
20. Listgarten MA, Lang NP, Schroeder HE, Schroeder A. Periodontal tissues and their counterparts around endosseous implants. Clin Oral Implants Res 1991;2:1-9.
21. Araujo MG, Lindhe J. Peri‐implant health. J Periodontol 2018;89:S249-S256.
22. Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410-1420.
23. B.-S. Kim, Y.-K. Kim, P.-Y. Yun et al., “Evaluation of periimplant tissue response according to the presence of keratinized mucosa,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 107, no. 3, pp. e24–e28, 2009.
24. Marin DO, Leite AR, Nícoli LG, Marcantonio C, Compagnoni MA, Marcantonio E, Jr, et al. Free gingival graft to increase keratinized mucosa after placing of mandibular fixed implant-supported prosthesis. Case Rep Dent 2017. 2017 5796768.
25. Wennstr¨om JL and Derks J. “Is there a need for keratinized mucosa around implants to maintain health and tissue stability?” Clinical Oral Implants Research, vol. 23, supplement 6, pp. 136–146, 2012.
26. Wiesner G, Esposito M, H Worthington H, and Schlee M., “Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory splitmouth randomised controlled clinical trial,” European Journal of Oral Implantology, vol. 3, no. 1, pp. 27–35, 2010.
27. Nemcovsky CE and Moses O , “Rotated palatal flap. a surgical approach to increase keratinized tissue width in maxillary implant uncovering: technique and clinical evaluation,” International Journal of Periodontics and Restorative Dentistry, vol. 22, no. 6, pp. 607–612, 2002.
28. Carnio J and Camargo PM, “The modified apically repositioned flap to increase the dimensions of attached gingiva: the single incision technique for multiple adjacent teeth,” International Journal of Periodontics and Restorative Dentistry, vol. 26, no. 3, pp. 265–269, 2006.
29.Elkhaweldi A, Soler CR, Cayarga R, Suzuki T, and Z. Kaufman Z, “Various techniques to increase keratinized tissue for implant supported overdentures: retrospective case series,” International Journal of Dentistry, vol. 2015, Article ID 104903, 7 pages, 2015
30. B¨uy¨ukerkmen E and Oncu E, “Gingival graft prior to and after delivery of implant-supported prostheses,” Clinical Oral Implants Research, vol. 25, p. 627, 2014.
31.Sohn J.-Y., Park J.-C., Cho K.-S., and Kim C.-S., “Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement,” Journal of Periodontal and Implant Science, vol. 44, no. 2, pp. 94–99, 2014.
32. Akcan KS, Güler B Hatipoğlu H. The effect of different gingival phenotypes on dimensional stability of free gingival graft: A comparative 6‐month clinical study. Journal of Periodontology, 2019, vol: 90 (7) pp: 709-717. Doi :10.1002/JPER.18-0530.
33. Lang NP, Loe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43: 623e627.
34. Miyasato M, Crigger M, Egelberg J. Gingival condition in areas of minimal and appreciable width of keratinized gingiva. J Clin Periodontol. 1977;4:200–209.
35. de Trey E, Bernimoulin JP. Influence of free gingival grafts on the health of the marginal gingiva. J Clin Periodontol. 1980;7:381–393.
36. Barone R., Clauser C., Grassi R., Merli M. & Prato G. P. (1998) A protocol for maintaining or increasing the width of masticatory mucosa around submerged implants: a 1-year prospective study on 53 patients. The International journal of periodontics & restorative dentistry 18, 377-387.
37. Bouri A.,Jr, Bissada N., Al-Zahrani M. S., Faddoul F. & Nouneh I. (2008) Width of keratinized gingiva and the health status of the supporting tissues around dental implants. The International journal of oral & maxillofacial implants 23, 323-326.
38. Grunder U. (2011) Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. The International journal of periodontics & restorative dentistry 31, 9-17.
39. Oh SL, Masri RM, Williams DA, Ji C, Romberg E. Free gingival grafts for implants exhibiting lack of keratinized mucosa: a prospective controlled randomized clinical study. J Clin Periodontol. 2017 Feb;44(2):195-203. doi: 10.1111/jcpe.12660. Epub 2017 Jan 24
2. Camargo PM, Melnick PR, Kenney EB. O uso de enxertos gengivais livres com objetivos estéticos. In: Nowzari H. Terapia Periodontal Estética. Periodontologia 2000, n.2, 72-96. Santos: São Paulo, 2003.
3. Cimões , R; Gusmão, ES; Donos, N. Practical manual for periodontal and periimplant surgery.1ed. 194-217. Nova Odessa,SP: book Publisher Napoleão, 2013.
4. Wara‐aswapati, N., Pitiphat, W., Chandrapho, N., Rattanayatikul, C., & Karimbux, N. (2001). Thickness of palatal masticatory mucosa associated with age. Journal of periodontology, 72(10), 1407-1412.
5. Lorenzana, E. R., & Allen, E. P. (2000). The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. International Journal of Periodontics and Restorative Dentistry, 20(3), 297-306.
6. Davenport IB. The American Dental Club of Paris. Meetings of December 1902 and January and March 1903. Dental Cosmos 1904; 46: 39-46.
7. The American Academy Of Periodontology [cited 2019 Jun 16]. Available from: https://c2-preview.prosites.com/131747/wy/docs/Glossary Of Periodontal Terms.pdf
8. Popova C BT. Free Gingival Autograft For Augmentation Of Keratinized Tissue And Stabilization Of Gingival Recessions. In: Journal of IMAB- Annual Proceeding (Scientific Papers) [Internet]. Sofia- Bulgaria: Department of Periodontology Faculty of Dental Medicine, Medical University - Sofia, Bulgaria; 2008 [cited 2019 Jun 16]. p. 7. Available from: https://www.journal-imab-bg.org/statii-08/vol08_2_19-25str.pdf
9. Agudio G, Pini Prato G, Cortellini P, Parma S. Gingival lesions caused by improper oral hygiene measures. Int J Periodontics Restorative Dent [Internet]. 1987 [cited 2019 Jun 16];7(1):52–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3471735
10. Hall WB. The Current Status of Mucogingival Problems and Their Therapy. J Periodontol [Internet]. 1981 Sep [cited 2019 Jun 16];52(9):569–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6169820
11. Nyush A. Niklaus P. Lang, Jan Lindhe-Clinical Periodontology and Implant Dentistry, 2 Volume Set-Wiley-Blackwell (2015).pdf [Internet]. [cited 2019 Jun 16]. Available from: https://www.academia.edu/36609597/Niklaus_P._Lang_Jan_Lindhe-Clinical_Periodontology_and_Implant_Dentistry_2_Volume_Set-Wiley-Blackwell_2015_.pdf
12. Sangnes G, Gjermo P. Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures. Community Dent Oral Epidemiol [Internet]. 1976 Mar [cited 2019 Jun 16];4(2):77–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1062255
13. Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol 2000 [Internet]. 2001 [cited 2019 Jun 17];27:72–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11551301
14. Bjorn H. Free transplantation of gingiva propria. Swed Dent J. 1963;nov(22):684–9.
15. Nabers JM. Free gingival grafts. Periodontics [Internet]. [cited 2019 Jun 18];4(5):243–5 1966. Available from: ttp://www.ncbi.nlm.nih.gov/pubmed/5223124
16. Shah R, Thomas R, Mehta S. Recent modifications of free gingival graft: A case series. [cited 2019 Jun 18];6:425. Available from: http://www.contempclindent.org
17. John V, Langer L, Rasperini G, Kim DM, Neiva R GH, Dibart S, Sanz M SE. Periodontal soft tissue non-root coverage procedures: practical applications from the AAP Regeneration Workshop: enhancing periodontal health through regenerative approaches. Clin Adv Periodont. 2015;5(1):11–20.
18. Scheyer ET, Sanz M, Dibart S, Greenwell H, John V, Kim DM, et al. Periodontal Soft Tissue Non–Root Coverage Procedures: A Consensus Report From the AAP Regeneration Workshop. J Periodontol [Internet]. 2015 Feb [cited 2019 Jun 17];86(2-s):S73–6. Available from: http://doi.wiley.com/10.1902/jop.2015.140377
19. Ashurko I.P et al., Keratinized Attached Gingiva around Dental Implants: The Role, Structure, Increasing Techniques., Indo Am. J. P. Sci, 2018; 05(10).
20. Listgarten MA, Lang NP, Schroeder HE, Schroeder A. Periodontal tissues and their counterparts around endosseous implants. Clin Oral Implants Res 1991;2:1-9.
21. Araujo MG, Lindhe J. Peri‐implant health. J Periodontol 2018;89:S249-S256.
22. Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410-1420.
23. B.-S. Kim, Y.-K. Kim, P.-Y. Yun et al., “Evaluation of periimplant tissue response according to the presence of keratinized mucosa,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 107, no. 3, pp. e24–e28, 2009.
24. Marin DO, Leite AR, Nícoli LG, Marcantonio C, Compagnoni MA, Marcantonio E, Jr, et al. Free gingival graft to increase keratinized mucosa after placing of mandibular fixed implant-supported prosthesis. Case Rep Dent 2017. 2017 5796768.
25. Wennstr¨om JL and Derks J. “Is there a need for keratinized mucosa around implants to maintain health and tissue stability?” Clinical Oral Implants Research, vol. 23, supplement 6, pp. 136–146, 2012.
26. Wiesner G, Esposito M, H Worthington H, and Schlee M., “Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory splitmouth randomised controlled clinical trial,” European Journal of Oral Implantology, vol. 3, no. 1, pp. 27–35, 2010.
27. Nemcovsky CE and Moses O , “Rotated palatal flap. a surgical approach to increase keratinized tissue width in maxillary implant uncovering: technique and clinical evaluation,” International Journal of Periodontics and Restorative Dentistry, vol. 22, no. 6, pp. 607–612, 2002.
28. Carnio J and Camargo PM, “The modified apically repositioned flap to increase the dimensions of attached gingiva: the single incision technique for multiple adjacent teeth,” International Journal of Periodontics and Restorative Dentistry, vol. 26, no. 3, pp. 265–269, 2006.
29.Elkhaweldi A, Soler CR, Cayarga R, Suzuki T, and Z. Kaufman Z, “Various techniques to increase keratinized tissue for implant supported overdentures: retrospective case series,” International Journal of Dentistry, vol. 2015, Article ID 104903, 7 pages, 2015
30. B¨uy¨ukerkmen E and Oncu E, “Gingival graft prior to and after delivery of implant-supported prostheses,” Clinical Oral Implants Research, vol. 25, p. 627, 2014.
31.Sohn J.-Y., Park J.-C., Cho K.-S., and Kim C.-S., “Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement,” Journal of Periodontal and Implant Science, vol. 44, no. 2, pp. 94–99, 2014.
32. Akcan KS, Güler B Hatipoğlu H. The effect of different gingival phenotypes on dimensional stability of free gingival graft: A comparative 6‐month clinical study. Journal of Periodontology, 2019, vol: 90 (7) pp: 709-717. Doi :10.1002/JPER.18-0530.
33. Lang NP, Loe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43: 623e627.
34. Miyasato M, Crigger M, Egelberg J. Gingival condition in areas of minimal and appreciable width of keratinized gingiva. J Clin Periodontol. 1977;4:200–209.
35. de Trey E, Bernimoulin JP. Influence of free gingival grafts on the health of the marginal gingiva. J Clin Periodontol. 1980;7:381–393.
36. Barone R., Clauser C., Grassi R., Merli M. & Prato G. P. (1998) A protocol for maintaining or increasing the width of masticatory mucosa around submerged implants: a 1-year prospective study on 53 patients. The International journal of periodontics & restorative dentistry 18, 377-387.
37. Bouri A.,Jr, Bissada N., Al-Zahrani M. S., Faddoul F. & Nouneh I. (2008) Width of keratinized gingiva and the health status of the supporting tissues around dental implants. The International journal of oral & maxillofacial implants 23, 323-326.
38. Grunder U. (2011) Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. The International journal of periodontics & restorative dentistry 31, 9-17.
39. Oh SL, Masri RM, Williams DA, Ji C, Romberg E. Free gingival grafts for implants exhibiting lack of keratinized mucosa: a prospective controlled randomized clinical study. J Clin Periodontol. 2017 Feb;44(2):195-203. doi: 10.1111/jcpe.12660. Epub 2017 Jan 24
Published
2019-11-15
How to Cite
NUNES, Marcelo Pereira et al.
Prosthetic Rehabilitation in Older Adult with Free Gingival Graft: Case Report.
International Archives of Medicine, [S.l.], v. 12, nov. 2019.
ISSN 1755-7682.
Available at: <http://imedicalpublisher.com/ojs/index.php/iam/article/view/2908>. Date accessed: 01 june 2023.
doi: https://doi.org/10.3823/2614.
Issue
Section
Dental Medicine
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