CONTEMPORARY ESTHETIC PERIODONTICS
Figure 18. Clinical preoperative photograph of the mandibular right posterior region showing decreased vestibular depth and lack of keratinized gingiva associated with implant # 47
Figure 19. An Intraoral periapical radiograph of the mandibular right posterior region showing implant # 47 with a healing abutment in place
Figure 20. Clinical intraoperative photograph showing the recipient bed on the buccal aspect of implant # 47
3.3. Case 3 Clinical Presentation A 35-year-old male non-smoker with noncontributory medical history presented to the Post Graduate Periodontology Clinic, Nova Southeastern University, Fort Lauderdale, Florida, in April 2016 with a chief complaint of“ my dentist said I may need some gum treatment around my implant.” Intraoral examination revealed good oral hygiene, an intact dentition with only one missing tooth # 47, which was replaced by a dental implant. Specifically, in the mandibular right posterior, there was lack of keratinized attached gingiva on the buccal aspect of the implant # 47( Fig. 18).
Figure 21. Clinical intraoperative photograph showing the donor site( right side of palate). An outline was made with a new 15c blade
An Intraoral periapical radiograph of the region is shown in Fig. 19. The patient also reported discomfort when brushing the healing abutment and expressed concern if this discomfort would be present after his dentist provides the final implant crown. The clinical findings were explained to the patient and what was recommended was to use a Free Gingival Graft harvested from the palate to create a band of attached keratinized gingiva and increase the vestibular depth around the implant. A written informed consent for periodontal surgery was obtained from the patient.
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