Clinical
Fig 7
Fig 8
Fig 9
Fig 10 Continued »
of the connective tissue graft into the area. The connective tissue can be
harvested from either the palate or the maxillary tuberosity area depending on the patient’s anatomy (Fig ıı). A partial thickness enve- lope incision is created in the facial aspect of the implant site to allow the introduction of the subepithe- lial connective tissue graft (=ı0mm x 7mm). The soft tissue graft is sutured
with a fine diameter suture material (5/0 vicryl or 6/0 prolene) using horizontal and vertical mattress sutures to hold the tissue and the papillae together. If the implant is not restored immediately then ideally a fixed ‘rochette’ bonded
Fig 11
retainer or a more cost-effective alternative like an ‘essix type’ remov- able retainer can be used without pressure on the facial soft tissues. Care should be taken to carefully
contour the provisional pontic so that it does not impinge on the facial soft tissues but does maintain and support the interproximal papillae. The patient was instructed not to brush the area for two weeks and rinse twice daily with a chlorhex- idine mouthwash. Sutures were removed at two weeks, at which point tissues should be pink and healthy with limited inflammation due to minimal trauma used in the surgical protocol (Fig ı2). The patient is then reviewed at
one and then three months post- operatively. After three months of healing, a small incision is made
Fig 12
“After three months of healing, a small incision is made to expose the healing abutment”
to expose the healing abutment as the tissue had grown over it (Fig ı3). Figure ı4 shows the implant six months after delivery of final restoration. Note the complete fill of inter-
proximal papilla, maintenance of the facial contours of the extraction site ridge and the increased thickness of the peri-implant soft tissues coronal to the implant-abutment interface (Fig ı5).
Case two A 29-year-old female patient was referred for immediate implant placement in ULı (Figs ı6 and ı7). The tooth, which already had under- gone endodontic therapy some years ago, had suffered a fracture well below the gingival margin one
Continued »
Fig 13
Fig 14
Fig 15
Fig 16
Fig 17
Fig 18 Ireland’s Dental magazine 21
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48