Multilayered connective tissue grafting technique: Case description of a novel soft tissue augmentation approach of 16 months follow-up

• BACKGROUND: Management of failed augmentation cases can be quite challenging to clinicians, because they might result in a more pronounced alveolar ridge defect. Therefore, management of failed augmentation cases requires enhancement of soft tissue quality through mucogingival procedures. In the present case report, we describe the application of a novel multilayered connective tissue grafting to perform a ridge augmentation in a Siebert class III defect after failed vertical guided bone regeneration. CASE REPORT: A 38-year old patient visited the Dental Clinic of the Ospedale Maggiore Policlinico, University of Milan, Italy for a chief complaint of unsatisfactory aesthetics in the upper jaw. Dental history disclosed failed preimplant vertical bone augmentation with GBR procedure in the area of left maxillary central incisor resulting in severe gingival recession of adjacent teeth & compromised soft tissue quantity & quality & severe ridge atrophy (class III). Multilayered connective tissue grafting technique, in a two- step mucogingival surgery, was used to cover the gingival recessions & reach even gingival margin. In the first-step, 2 grafts were utilized: The 1st one was folded to form two layers secured on the occlusal side. The 2nd graft was cut in two parts; The 1st was sutured on the periosteum of the buccal side and the 2nd was sutured occlusally. The flap was then coronally advanced. The second-step surgery was performed 6 months after the first one, due to incomplete coverage. There was no probing around the area of the first surgery. Same flap design applied in the 1st surgery was utilized. After split thickness flap elevation, probing depth around anterior maxillary teeth was 2 mm. Six months after 2nd mucogingival surgery, frenectomy was done to relieve muscle attachment. Fixed bridge was cemented 16 months after the 1st mucogingival surgery. Clinical & radiographic satisfactory outcomes were reached CONCLUSIONS: Through this case report, we can conclude that: Multilayer connective tissue grafting technique might be successful in correcting soft tissues after failed bone augmentation procedures; Vertical soft tissue augmentation is possible with this technique; Soft tissue management through mucogingival surgery is fundamental in correcting failed GBR cases, especially in the aesthetic zone.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Odontologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Dentistry (hsv//eng)

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