Altered Passive Eruption

If we place the implant without making the right diagnosis we ar at risk of placing our implant too far coronal then we should. 

 

How can we treat in just one surgical time, altered passive eruption and immediate implante placement? Altered passive eruption is treated with submarginal incision at the buccal (full thickness incision) and split thickness at the level of the interdental papillae. Ostetomy reduction of the teeth is done with scalpel blade, about 3mm.

 

Periosteal releasing incision only at the future implant site, that’s the only part we want to CAF

 

Graft harvesting, apical horizontal incision only after the graft is totally released

 

We start desepithelialization from the middle of the graft, we do one half first and then the other half, we use our finger to hold it firmly.

 

We suture the graft to the inner surface of the flap. We enter first at the base of the surgical papilla, and then perforate 3mm below the graft’s border and suture it to the base of the surgical papilla, base of surgical papila means about 5mm apical to its peak (3mm apically to the the marginal gingiva)

 

 

 

LACK OF THE BUCCAL BONE

(15'26'')

One of the most important aspects of the mucogingival approach is to elevate the interdental papillae in split thickness. Another great advantage of the mucogingival approach is you can treat adjacent gigngival recessions simultaneously to implant placement. Recession is treated only with the simple CAF, with no graft. 

 

Tooth is extracted. Severe loss of the buccal plate is observed. Implant is placed. Particulate bone graft (autologous and xenograft) is performed. A pericardium membrane is sutured to the adjacent periosteum covering all the buccal bone graft. We harvest the FGG from the palate, a more extended one than usual, as we have a huge buccal wall defect. We desepithelialize the graft. We suture it against the inner surface of the flap. Before placing the provisional crown the distal papilla is sutured a simple suture, provisional crown is placed and then another simple suture is done mesially. After that a sling suture is done to further displace the entire complex coronally.