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Attached Gingival on Left and Alveolar Mucosa on Right: Proper Technique?

posted in Treatment Planning & Complications, Techniques and Procedures, Tissue Regeneration, advice

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Dr. A. asks:
I have just placed 2 Ankylos dental implants at the subcrestal postion in the mandible at the canine positions [#22, 27 or 33,43]. On the left side there is 1mm attached gingival and on the right there is no attached gingival – just alveolar mucosa. The implants are 14mm long. They are also approximately 15 degrees divergent in the mesio-distal plane. The alveolar ridge posterior to the implants bilaterally is severely atrophied. My treatment plan is for a mandibular overdenture with attachments on the two implants. Should I graft attached gingival around the implants? Will attachments on free-standing implants suffice or do I need to do a Hader bar?

12 Responses to “ Attached Gingival on Left and Alveolar Mucosa on Right: Proper Technique? ”

• Neda-Moslemi December 2nd, 2008

  
  

  As a periodontist, the presence of keratinized attached gingiva around implants is always preferred, although there are several controversial opinions about the importance of it in the literature.
  Neda Moslemi

• Dr S December 2nd, 2008

  
  

  Attached Gingivo mucosa is mandatory around Implants and teeth in length breadth and thickness of which thickness is most important. Rush for a periodontists opinion and intervention.

• doctorberg December 2nd, 2008

  
  

  I would graft with alloderm or a similar to get good thick gingiva and the restore.
  best of luck

• Nuno December 7th, 2008

  
  

  Can you post a X-ray. Thanks

• R. Hughes December 7th, 2008

  
  

  Consider a “poncho” graft with alloderm. Remenber to perform a split-thickness incision about the implants.

• Neda-Moslemi December 8th, 2008

  
  

  Alloderm is very effective in increasing the thickness of the mucosa, but it does not induce keratinized tissue. Alloderm can be the second choice not the first.
  The autogenous gingival graft is the best choice.

• s-yaghobee December 8th, 2008

  
  

  presence of attached(and ofcourse keratinized) gingiva around implant is essential and ,in my opinion , one of the cardinal preriquisite for sucsess in implant procedure . i agree neda-moslami
  the first & the best way to augment K.G is autogenous gingival graf which could be done 1) perior of the fixture insertion 2)at the time of implantation 3) before supra structure procedure.

• Walid Elebiary December 8th, 2008

  
  

  3 mm minimum zone of attached gingiva is mandatory to maintain good gingival health arround teeth or implants, however some authors question it.
  There are three diffirent ways for gingival augmentation:
  1- Free mucosal graft
  2- Subepithelial CT graft
  3- Alloderm

• Jig December 9th, 2008

  
  

  Why do you need to graft if your implants are subcrestal.As you have used Ankylos Implants there wont be much bone loss after osseointergation period.
  After about 3 months,you can directly attach a bar or a ball substructure and construct ure over denture.
  I generally prefer Ball attachments..

• Dr S December 9th, 2008

  
  

  Dear Dr Jig, no matter what, attached tissue is mandatory around an Implant/tooth irrespective of whether the implants are placed sub crestaly or not.

  It’s more to do with resistance of the tissues to plaque around the implant /tooth. Longer and thicker the attached the gingiva better the long term result you get.I am no periodontist but my advice is commonplace. Or else the peri-implant soft tissue will perpetually remain inflammed from plaque and calculus.

  But my basic doubt in this case is that it is least likely that there is no attached tissue. Please look closely.

• Dr S December 9th, 2008

  
  

  Dermis is better than Alloderm

• coxsakie December 14th, 2008

  
  

  Neda Moslemi i think it is clearly pointed in the literature that the only thing that the attached gingiva does around Imps is to make the brushing more easy and painless, this way effective.So i think u need to do the Alloderm graft.As far as the bar is concerned i according to the literature, the patient satisfaction with bar or balls is about the same.Plus theres no need to splint two 14mm imps for an overdenture.So do what feels easier for u.both is good.And do the bone a favor, stop placing imps subcrestally.Read what Tarnow and Jovanovic say about the biological width around Imps and stop violating it.

  The only indication for subcrestal palcement is free standing imps in the esthetic zone and even that is nowadays questionable thanks to
  the platform switch concept

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