CONTEMPORARY ESTHETIC PERIODONTICS
Figure 12. Clinical intraoperative photograph showing the recipient bed around the teeth and in the pontic region
Figure 13. Clinical intraoperative photograph showing the donor site( right side of palate). An outline was made with a new 15c blade
Figure 14. Clinical intraoperative photograph showing the graft stabilized and immobilized via periosteal and single interrupted sutures
palate to create a band of attached keratinized gingiva and increase the vestibular depth. Witten informed consent for periodontal surgery was obtained from the patient. Case Management The attached keratinized gingiva is dense, resilient and tightly attached to the underlying tooth and bone, while the alveolar mucosa is thin, mobile, and apparently less capable of withstanding the functional stresses of mastication and oral hygiene practiced by the patient. The autogenous free gingival graft is a predictable surgical procedure to increase the width of keratinized attached gingiva, eliminate frenum and muscle pull, and to extend the vestibular depth depth 18. After the administration of anesthesia to the
recipient site via local infiltrations on the buccal and palatal aspect of the maxillary right posterior region, periodontal curettes were used for subgingival debridement of the root surfaces of teeth # 16 & # 14 without damaging the crown margins, then the FPD was wiped with gauze soaked in 0.12 % chlorhexidine for 30 seconds. Subsequently, the recipient site’ s epithelium, CT, and muscle fibers were sharply dissected down to the periosteum using 15c and 12 blades and microscissors to create a large recipient bed around the teeth and in the pontic region( Fig. 12). Immediately after, a Free Gingival Graft was harvested from the right side of the palate using a new 15c blade( Fig. 13). The graft was immediately transferred to the recipient site, which was stabilized and immobilized via periosteal and single interrupted sutures with 4.0 chromic gut sutures( Fig. 14). Finally, tactile pressure was placed over the graft to remove any blood clots between the graft and recipient bed and to achieve close adaptation of the graft. No periodontal dressing was used to cover the graft and the patient was instructed to follow a liquid diet for the first 24 hours, followed by a soft diet for the remaining week and eat on the left side only. Patient was instructed to refrain from oral hygiene practices in the surgical site while rinsing with 0.12 % chlorhexidine gluconate( three times daily) for 2 weeks, take 500 mg Amoxicillin( every 8 hours) for 7 days and 800 mg Ibuprofen( every 8 hours) as needed for discomfort. The postoperative follow-ups were conducted at 1( Fig. 15 A & B), 3( Fig. 16 A), and 6 weeks( Fig. 16 B). Clinical Outcomes Healing was uneventful at both the donor and recipient sites. At the 1-week follow-up only visual examination was performed which revealed slight erythema and edema consistent with normal postsurgical healing and no swelling or infection was
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