PMC5331288_01
Initial appearance of the gingival tissue around the implants.
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In addition, it was verified on the mandible the absence of KM on the buccal side of interforaminal area, shallow vestibule, presence of bacterial place around the healing caps, and complaint of painful symptoms in the gingival tissue around the implants (Figure 1).
Checking the fitting of prostheses in mouth.
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Afterwards, both prostheses were installed and the fitting and adaptation were checked. (Figure 2).
Plaque accumulation on the prosthetic components after 30 days of installation of definitive prostheses.
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After 30 days, the patient returned for maintenance of the prostheses and plaque accumulation was observed in the peri-implant area on the prosthetic components (Figure 3).
Partial-thickness flap on the buccal side of the interforaminal area around the implants.
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An intrasulcular incision was performed and a partial-thickness flap was made on the buccal side of the interforaminal area around the four dental implants (Figure 4).
A sterile paper to make a map with the size of the recipient bed and transferred to the palate.
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A sterile paper was used to make a template with the same size of the recipient bed, which was transferred to the palate in order to remove two free 1.5 mm thick gingival grafts (Figure 5).
Free gingival graft placed around the implants.
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The same protocol described above was applied to the second portion of the graft on the right surgical area (Figure 6).
Surgical cement in the recipient bed and stabilized on the mandibular prosthesis.
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The mandibular fixed implant-supported prosthesis was installed in the mouth and surgical cement was added in the recipient bed and stabilized on the mandibular prosthesis (Figure 7).
Six months of follow-up after surgery showed a good health of peri-implant tissues and absence of plaque accumulation.
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After a 6-month period of follow-up (Figure 8), it was observed an improvement of thickness and a 3 mm increase in the height of keratinized mucosa, promoting a good peri-implant health and facilitating the hygiene procedures.