Case report of using partially epithelialized connective tissue graft for peri-implant soft tissue augmentation simultaneously with dental implant placement

Background. The novelty of present case report is related to the fact that it represents achievement of successful results of dental implant-borne rehabilitation in means of forming appropriate pink esthetic profile and sufficient peri-implant soft tissue stability while using for such purpose partially epithelized connective tissue flap simultaneously with delayed implant placement procedure, which to the knowledge of authors have been described in the specialized literature before only in scarce manner. Objective. To demonstrate clinical option of using partially epithelialized connective tissue graft for peri-implant soft tissue augmentation simultaneously with dental implant placement procedure to enhance peri-implant esthetic profile and optimize soft-tissue stability for further prosthetic rehabilitation. Case report. Patient 46 years old patient referred to the dental clinic with complaints regarding condition of mandibular fixed denture, which he was using already for 9 years. Also, patient informed dentist that he wants to improve his chewing ability by restoring edentulous distal regions of mandible with implant-borne fixed dentures. Patient previous denture was gently deattached from mandibular abutment teeth while not altering periodontal conditions of any of them during procedure. All the targeted and periodontal treatment was provided based on clinical need. Tissue level implants were placed at the projection of teeth 4.5-4.6 and 3.6-3.7 due to the conventional implant placement protocol. To compensate soft tissue collapse within the implant placement region it was decided to augment such with partially epithelialized connective tissue graft. Graft was shaped, prepared and partially de-epithelialized to overcome issue of volume excess using standard technique. Partially epithelialized connective tissue graft was positioned carefully with the manner of the epithelial portion covering dental implant part, while connective tissue portion was facing inner surface of separated flap, and was covered by a flap. Modified horizontal mattress sutures were used to secure connective tissue graft at the place while retaining its primarily established positions and guaranteeing tension-free flap closure around installed healing abutments. Results of final rehabilitation outcomes with satisfactory appearance of the soft tissue condition around fixed prosthetic construction were achieved at the end of the treatment. Conclusion. Partially epithelized connective tissue graft combines features of both connective tissue graft, which makes it suitable for mucosa thickness gain, and free gingival graft, whin in turn helps to increase width of keratinized gingiva. Such universal properties make it suitable candidate for the usage simultaneously with implant placement to enhance peri-implant esthetic profile and optimize surrounding soft-tissue stability for further prosthetic rehabilitation. Ethical aspects Authors confirm that they have followed all relevant ethical norms and requirements during the treatment described within present case report and preparation of present manuscript. Authors obtained full patient’s agreement regarding publication of following case report, and such was approved by corresponding consent form signed by the patient personally. No information in present case report may disclose any personal data about the patient, which further may be used for patient’s personal identification. Any information related to patient’s identity disclosure was either deleted or anonymized within present case report. Authors confirm that they have followed CARE guidelines while preparing present case report with intention for further publication. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.