Often, the alveolar ridge is adequate for proper implant placement, but the overall “contour” of the ridge is deficient. If this is not addressed surgically, it could result in an emergence profile where the buccal of the restoration is bulky, acts as a food trap, and compromises esthetics.
In a case like this, as shown below, I prefer to use DALI Acellular Dermis, a dermal allograft or Acellular dermal matrix (ADM) , as a soft tissue substitute instead of elevating an extensive flap to facilitate graft and membrane placement. A quick pre-soak in saline will allow the DALI Acellular Dermis graft to slide right under the limited buccal flap and sufficiently augment the buccal contour.
Beautiful!!! Could you please share your reason for ADM vs autogenous connective tissue. I think this is an excellent case and one well suited for the use of the ADM as it has an adequate amount of attached gingiva. This same technique would not be appropriate if the surrounding soft tissue were more mucosa and unfortunately the training courses often skip over that… I have noticed that in nearly every publication the final Gee Wiz result pics always have an abundance of healthy soft tissue leading me to wonder if the surrounding gingiva might just be more important than any material placed in the area. I certainly believe that the outer protective layer (gingiva) is the most important and serves to protect all of the stuff under it…
Another option is the osteo-periosteal flap with facial ridge expansion. This can be done flaplessly with immediate implant placement. The outcome would provide osseous support and gingival improvement.
Dennis Flanagan DDS MSc (oral implantology)
Hi TCPerio- I would be interested in knowing more about your experience using CTG on implants in particular at second stage- just for buccal thickness (k tissue is fine). How
much thickness can be obtained? Do you put the healing abutment (s) on? What do you think about using it here? Thx!
@tcperio I think you answered it. Adequate bone, adequate soft tissue thickness, adequate KT= perfect case for ADM so that we could avoid going anywhere else in the mouth for autogenous tissue. @dffddsmsc I am not familiar with this technique but I would like to understand more how you do a flap but flapless? @pinkandwhite Do you have any more information? A radiograph of the implant and an occlusal photo would help in determining the best protocol for this particular case.
Basically just do whatever you would normally do except add some CT to the buccal. Yes I would do it here and yes I would put the healing abutment on. If a lot of thickness is needed then place a graft material of choice, I usually use Bovine xenograft when looking for contour, and just drape the CT over the graft like a poor man’s membrane.
