PMC6280019_01
Initial clinical aspect.
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P., 29-year-old male patient, nonsmoker, nondrinker, not taking any medication, and with no relevant family history, with an implant-supported crown in central incisor #11 fabricated 8 months before, was dissatisfied with the final esthetic outcome (Fig. 1).
Screw access hole through the buccal surface.
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Clinical examination revealed a screw-retained prosthesis through the incisal surface (Fig. 2), covered with photoactivated composite resin, stained over time by coloring agents.
Assessment of gingival retraction in the buccal region, compared with the cervical region of tooth #21.
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The gingiva was vertically retracted in the buccal region of the crown (approximately 2 mm), when compared with the cervical region of tooth #21 (Fig. 3).
4A - Horizontal incision in the alveolar mucosa; 4B -Gingival repositioning with combination of Tarnow's and pinhole surgical techniques.
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Initially, the patient was anesthetized with articaine 4% + epinephrine 1:100,000 (DFL , Rio de Janeiro), and then two horizontal 2-mm incisions were made, separated by 3 mm of intact gingival tissue, using blade #15 in the alveolar mucosa, close to the top of the implant (Fig. 4A). After detachment of gingival tissues, making them flabbier, the flap was stabilized using horizontal mattress suture (nylon 4.0) through the incision site with the knot tied in the palatal gingiva, thus preserving the gingival papillae (Fig. 4B).
5A - Confirmation of gingival position after periodontal surgery. The papillae were preserved; 5B -10 days after surgery showing healthy gingival tissue without gingival recession; 5C -Final clinical aspect after 3 months; 5D - Final clinical aspect after 19 months.
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The gingival mucosa was assessed using a periodontal probe moved horizontally (Fig. 5A). After 10 postoperative days, the gingival tissue showed satisfactory healing, with no signs of recession, infection, or inflammation, and no intercurrent events (Fig. 5B). In addition to gingival alignment with the adjacent teeth, the gingival papillae properly filled the interdental spaces (Fig. 5C). In the follow-up visit at 19 months, the peri-implant tissues were healthy without gingival retraction, and the morphology was preserved, with presence of keratinized gingival tissues along the anatomic shape of the prosthetic rehabilitation (Fig. 5D).