PMC4168148_01
Initial appearance. Note exposure of threads and the absence of keratinized mucosa.
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fig1
Also, the lack of keratinized tissue in this region and some degree of inflammation of the soft tissues were observed that combined with radiographic images featured a diagnosis of peri-implantitis (Figures 1, 2, and 3).
Radiographic initial appearance.
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fig2
Also, the lack of keratinized tissue in this region and some degree of inflammation of the soft tissues were observed that combined with radiographic images featured a diagnosis of peri-implantitis (Figures 1, 2, and 3).
Recipient site prepared to receive the free gingival graft.
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fig3
Also, the lack of keratinized tissue in this region and some degree of inflammation of the soft tissues were observed that combined with radiographic images featured a diagnosis of peri-implantitis (Figures 1, 2, and 3).
PMC4168148_02
Graft sutured into the recipient site only in keratinized mucosa and periosteum.
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fig4
After complete stabilization of the graft on the receptor site, keratinized mucosa and adjacent periosteum (Figure 4), the patient was released and was prescribed a nonsteroidal anti-inflammatory, every 12 hours for 3 days.
PMC4168148_03
Postoperative aspect 7 days after surgery.
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fig5
Seven, 21, and 90 days, postoperatively, the patient returned to the clinic with a satisfactory status regarding the success of the technique of grafting but without the covering of exposed threads (Figures 5, 6, and 7).
Postoperative aspect 21 days after surgery: the exposure of threads in the element 23 still exists.
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fig6
Seven, 21, and 90 days, postoperatively, the patient returned to the clinic with a satisfactory status regarding the success of the technique of grafting but without the covering of exposed threads (Figures 5, 6, and 7).
Postoperative aspect 90 days after surgery: indication for subepithelial connective tissue graft.
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fig7
Seven, 21, and 90 days, postoperatively, the patient returned to the clinic with a satisfactory status regarding the success of the technique of grafting but without the covering of exposed threads (Figures 5, 6, and 7).
Connective tissue graft sutured to the recipient site.
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fig8
In both of the surgical techniques, citric acid and tetracycline were used on the exposed surface of the implant (Figures 8 and 9).
Immediate postoperative aspect after subepithelial connective tissue graft.
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fig9
In both of the surgical techniques, citric acid and tetracycline were used on the exposed surface of the implant (Figures 8 and 9).
PMC4168148_04
Postoperative aspect 7 days after surgery.
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fig10
In the controls after 7 and 21 days, the latter procedure, despite creating a volume of soft tissue, failed to cover the threads of the implant (Figures 10 and 11).
Postoperative aspect 21 days after surgery: note that the connective tissue graft failed to cover exposed threads.
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fig11
In the controls after 7 and 21 days, the latter procedure, despite creating a volume of soft tissue, failed to cover the threads of the implant (Figures 10 and 11).
Postoperative aspect 90 days after the second surgery: presence of the phenomenon of "creeping attachment" with partial coverage of the implant's threads.
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fig12
Ninety days after the second surgery, there was coronal migration of peri-implant mucosa, which then covered 2 of the 3 exposed threads (Figure 12).
Postoperative absence of peri-implant pocket in 6 months.
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fig13
Periodical recall appointments were performed and a survey of peri-implant sulcus depths was completed noting the absence of pockets 6 months after the surgery (Figure 13).
One year after the surgery. Note the almost total coverage of the implant platform.
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fig14
The cervical tissue migration still occurred after 1 year (Figure 14) until it stabilized during the postoperative period of 2 years (Figure 15), where we observed a complete coverage of the threads and the implant platform in the region of tooth number 23, leaving only the vestibular portion of the metallic collar inherent to the angled abutment.
Two years after the surgery. Covering all of the threads of the implant and the platform due to the phenomenon of "creeping attachment."
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fig15
The cervical tissue migration still occurred after 1 year (Figure 14) until it stabilized during the postoperative period of 2 years (Figure 15), where we observed a complete coverage of the threads and the implant platform in the region of tooth number 23, leaving only the vestibular portion of the metallic collar inherent to the angled abutment.
PMC4168148_05