Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10738
Peer-review started: August 15, 2021
First decision: September 2, 2021
Revised: September 14, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: December 6, 2021
Keratinized gingival insufficiency is a disease attributed to long-term tooth loss, can severely jeopardizes the long-term health of implants. A simple and effective augmentation surgery method should be urgently developed.
A healthy female patient, 45-year-old, requested implant restoration of the her left mandibular first molar and second molar. Before considering a stage II, as suggested from the probing depth measurements, the widths of the mesial, medial, and distal buccal keratinized gingiva of second molar (tooth #37) were measured and found to be 0.5 mm, 0.5 mm, and 0 mm, respectively. This suggested that the gingiva was insufficient to resist damage from bacterial and mechanical stimulation. Accordingly, modified apically repositioned flap (ARF) surgery combined with xenogeneic collagen matrix (XCM) and platelet-rich fibrin (PRF) was employed to increase the width of gingival tissue. After 1 mo of healing, the widths of mesial, medial, and distal buccal keratinized gingiva reached 4 mm, 4 mm, and 3 mm, respectively, and the thickness of the augmented mucosa was 4.5 mm. Subsequently, through the second-stage operation, the patient obtained an ideal soft tissue shape around the implant.
For cases with keratinized gingiva widths around implants less than 2mm，the soft tissue width and thickness could be increased by modified ARF surgery combined with XCM and PRF. Moreover, this surgery significantly alleviated patients’ pain and ameliorated oral functional comfort.
Core Tip: The advantages of keratinized gingiva augmentation with xenogeneic collagen matrix and platelet-rich fibrin included: (1) Promotion of soft tissue regeneration; (2) Low risks of infection and pain; (3) Minimally invasive procedure; and (4) Simplified surgical process.