PMC5660301_01
Pre operative
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In the fourth quadrant there was attached gingiva of about 3mm present on mesial implant but the distal implant showed less < 2mm of width of attached gingiva (Figure 1).
PRF membranes secured with sling sutures
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The 2 PRF membrane's are placed over lapping each other to cover all the three implants and are secured around the gingival former with the help of sling sutures (Figure 2).
Vestibuloplasty with PRF membrane in 3rd quadrant
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The coronal end of the partial thickness flap is positioned apically and sutured along with the apical end of the PRF membrane, to the underlying periostium, using 4-0 silk (Figure 3) (vestibuloplasty with PRF membrane).
Vestibuloplasty with PRF membrane in 4th quadrant
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PRF membrane was then placed over the exposed connective tissue bed and secured around the gingival former with stabilizing suture and sling suture respectively (Figure 4) (vestibuloplasty with PRF membrane).
Day 1 after surgery, PRF membrane whitish in colour
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In both the quadrants, on day 1 after the surgery, the surface of the PRF membrane appeared whitish in colour (Figure 5) but by day 8, neo-angiogenesis had set it and many new immature blood vessels were seen (Figure 6).
After 8 days, new immature blood vessels seen
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In both the quadrants, on day 1 after the surgery, the surface of the PRF membrane appeared whitish in colour (Figure 5) but by day 8, neo-angiogenesis had set it and many new immature blood vessels were seen (Figure 6).
After 4 week, sufficient coverage of exposed implant surface
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By the end of 4 weeks (Figure 7) the change in the tissue biotype from thin to thick, sufficient coverage of the exposed implant surfaces was achieved, there was evident increase in the vestibular depth and on pulling of the lower lips, no blanching of the marginal gingiva was visible.