The expanded mesh free gingival graft: A novel approach to increase the width of keratinized mucosa.

BACKGROUND: The importance of an adequate amount of peri-implant keratinized tissue and attached mucosa has recently been emphasized. This manuscript presents preliminary findings of a novel approach for increasing the width of keratinized mucosa (KM) around dental implants using a mesh free gingival graft (mesh-FGG). METHODS: Two healthy adults were treated as part of this study. After implant placement, a large edentulous alveolar ridge with shallow vestibule and minimal amount of KM was treated in both subjects (one in the posterior mandible and the other in the anterior mandible) with the combination of an apically positioned flap and a mesh-FGG. Clinical, esthetic and patient-reported outcomes were observed at approximately 4-month time points. RESULTS: All sites healed uneventfully after the treatments. In both cases, increased vestibule depth, soft-tissue thickness, and width of peri-implant KM were obtained. The patients did not report any accessory discomfort. Four months following the grafting procedure, good overall esthetic outcome was observed with minimal color disparity and graft demarcation. CONCLUSIONS: Width of KM around dental implants can be increased using a mesh-FGG. Randomized controlled clinical studies comparing mesh-FGG to conventional FGG and other commonly applied techniques are required to assess the long-term efficacy of this novel technique in terms of soft-tissue thickness, width of peri-implant KM, and patient-reported outcomes. KEY POINTS: Principal Findings: Meshed-FGG allowed an expansion of the length of the harvested graft. This results in coverage of large recipient sites, increase in height of KM and good aesthetic integration of the graft.

The Trapezoidal Sling Suture: A Technical Note of a Novel Suturing Technique for Tunneling Flap Procedures.

The aim of this report is to describe a new sling suturing method with papillary anchorage that is found clinical applicable within the available conventional tunneling root-coverage procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, it ascertains a firm and stable connection for the entire bucco-gingival-graft complex into the horizontal and vertical dimension of both single and multiple recession defects. This technical note described the "trapezoidal sling suture" technique, that allows fixation and stabilization for graft and flap around both natural teeth and implants.

Comparison of two different techniques for deepithelialization: a split-mouth case series.

AIM: The aim of the present preliminary study was to observe and make a histologic comparison of connective tissue grafts (CTGs) harvested from the lateral palatal mucosa through the use of two different harvesting techniques. MATERIALS AND METHODS: Three patients were enrolled in the study, providing six standardized CTGs. One well-experienced periodontist collected the replacement grafts using two different methods. After outlining the grafts to a fixed dimension, the graft on one side was deepithelialized by a round coarse bur intraorally before harvesting. The graft on the contralateral side was obtained by harvesting from the palate first; subsequently, deepithelialization was performed extraorally with the aid of a no. 15c blade. After finalization, histologic evaluation was performed. RESULTS: No apparent differences were found between the two observed techniques in terms of graft thickness, proportion, and composition. After deepithelialization, epithelial remnants were clearly evident in five out of six cases. Despite being more technique sensitive, the removal of epithelium by bur scored better. Proper graft handling and graft regularity are described as advantages of the more conventional epithelial excision by blade. CONCLUSIONS: Despite the wide use and broad variety of commonly applied techniques of graft deepithelialization, the present authors assume that full excisions with the use of a blade are hardly ever achieved. Despite the unpredictable retrieval of epithelium by blade, graft handling and graft regularity can be proposed as the biggest advantages. On the other hand, the presented novel in situ deepithelialization with a round bur seems to be more predictable.