PMC6334554_01
(a) Vestibular and (b) occlusal view showing the small amount of keratinized gingiva
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F1
The absence of tooth 34 and marginal level of keratinized gingiva was observed [Figure 1].
Horizontal incision below the mucogingival line and the bony crest
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F2
A horizontal incision was made under the bony crest of the edentulous space just below the mucogingival line [Figure 2].
Vertical incision made in the mesial
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F3
Two vertical incisions of approximately 4 mm were made, one in the mesial [Figure 3] and one in the distal area [Figure 4] of the edentulous space.
Vertical incision was made in the distal
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F4
Two vertical incisions of approximately 4 mm were made, one in the mesial [Figure 3] and one in the distal area [Figure 4] of the edentulous space.
Papilla of teeth 33 and 36 preserved
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F5
The papilla was preserved [Figure 5].
A partial thickness flap was performed in the buccal region of the mandible
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F6
A partial thickness, 5 mm flap was made on the vestibular mucosa [Figure 6].
Harvesting graft from the palate
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F7
The free gingival graft was removed from the palate region between 2.0 mm-3.0 mm thickness and 30.0 mm of length [Figure 7].
Removal of the epithelium tissue from part of the free gingival graft with the aid of a 15C scalpel blade
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F8
Before placement in the recipient bed, one part of graft was cascaded (epithelial tissue was removed) [Figure 8] is the modification of the classical technique of free gingival grafting.
(a) Suture starting in the lingual mucosa, passing through the de- 9:epithelized graft and returning to the lingual mucosa, the graft is tractioned by the suture under the mucosa of the osseous ridge; (b) part of the epithelized graft covers the partial thickness flap on buccal side
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F9
The bony crest portion of the deepithelialized graft was enveloped with the aid of a horizontal mattress suture under the flap [Figure 9].
(a) A compression suture and (b) two simple mesial and distal sutures were made for the graft stabilization
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F10
Compression sutures were made to stabilize the graft on the vestibular region of mandible [Figure 10].
Occlusal view of the keratinized gingiva thickness (a) before the surgical procedure and (b) after 90 days
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F11
After 90 days, an increase, in keratinized tissue was observed both horizontally and vertically, making the site more suitable to receive the dental implant [Figure 11].
After 90 days, a vertical increase of the gingiva was observed after implant installation
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F12
A new gingival measurement was performed using a millimeter probe during installation of the implant, more than 3.0 mm of keratinized mucosa height was observed [Figure 12].
Thickness and height of the keratinized tissue remained unchanged after installed healing cap
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F13
The implant was installed with the healing cap, and the patient was instructed to return for a follow-up appointment after 30 days, and it was observed that the thickness and height of the keratinized tissue remained unchanged [Figure 13].