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Clinical Case Report

Connective-Tissue Graft to Increase the Width of the Keratinized Mucosa Around an Osseointegrated Implant

Vincenzo Iorio Siciliano

Adequate peri-implant soft-tissue thickness is essential not only for esthetic but also for functional reasons. In this case, Vincenzo Iorio Siciliano demonstrates how he achieved increased height and thickness of posterior peri-implant soft tissues to obtain a stable mucosal seal and a width of keratinized tissue favorable to toothbrushing.

The patient, a healthy 38-year-old woman, was referred for increasing the width of the keratinized tissues at the buccal aspect of dental implant 46. The site exhibited a premature-closure screw exposure caused by trauma during chewing, with inadequate keratinized tissue.

Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 12
Purchase price
10 Academy Coins
CPD/CME
0.25 hours

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General information

Case Type
Jaw Mandible
Area Posterior
# of Teeth 1
# of Implants 1
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation No
Augmentation Materials -
Guided Surgery No
Soft Tissue Grafting Staged
Abutment Type Standard
Prosthesis Type FDP

Esthetic Risk Assessment

Esthetic Risk Factors Low Medium High
Medical Status Healthy Compromised
Smoking Habit Non-smoker Light smoker (< 10 cigarettes per day) Heavy smoker (>= 10 cigarettes per day)
Patient's Esthetic Expectations Low Medium High
Lip Line No exposure of papillae Exposure of papillae Full exposure of mucosa margin
Periodontal Phenotype Low-scalloped, thick Medium-scalloped, medium-thick High-scalloped, thin
Shape of Tooth Crowns Rectangular Triangular
Infection at Implant Site None Chronic Acute
Bone Level at Adjacent Teeth <= 5 mm to contact point 5.5 to 6.5 mm to contact point > 7 mm to contact point
Prosthodontic Status of Neighboring Teeth Virgin Restored
Width of Edentulous Span 1 tooth (>= 7 mm) 1 tooth (< 7 mm) 2 teeth or more
Soft Tissue Anatomy Intact Defective
Bone Volume Horizontally and vertically sufficient Horizontally deficient Deficient vertically or deficient vertically AND horizontally

  • * General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.

  • ** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.

Surgical SAC classification

SAC Level Straightforward
Defining Characteristics One missing tooth to be replaced by an implant-borne prosthesis
Modality Modality
Placement Protocol Early or late implant placement
Tooth Site Tooth site
Socket Morphology Socket morphology
Socket Integrity Socket integrity
Bone Volume Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk Low
Complexity Low
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Straightforward
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
Retention -
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance -
Bruxism -
Esthetic Risk Low
Provisional Implant-Supported Prosthesis -
Interim Prosthesis during Healing -
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

Oral Hygiene and Compliance Good
Access Adequate
Craniofacial/Skeletal Growth Completed
Publication date: Apr 25, 2023 Last review date: Apr 18, 2023 Next review date: Apr 18, 2026

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