The purpose of this post is to ask my colleagues of their view on placement of maxillary anterior implants when the vestibule is very shallow, and the zone of attached gingiva very narrow. Coming from the crest of the ridge toward the vestibule there is about 3-4 mm of vertical height. There is enough bone to place a fairly good size implant of about 11 mm length.
To graft a band of tissue of any height over 2 mm would place the graft in the vestibule. The existing attached gingiva is thick, not fragile. This condition existed prior to the loss of teeth and the the teeth were lost because of decay, failed endodontics not because of periodontal conditions.
Is vestibuloplasty the only alternative?