Treatment of peri-implant soft tissue dehiscence around implants placed in calvarial bone graft maxilla and mandible 20 years ago: A case report

Introduction: Despite tissue augmentation and management prior implantation, long-term observation can reveal a change in peri-implant phenotype with some lack of keratinized mucosa (KM). The treatment approach of peri-implant dehiscence in multiple implants is not clearly defined. This report describes the different periodontal surgical approaches undertaken to promote the gingival margin stability and to prevent the peri-implant mucosal inflammation over time. Case Presentation: A 64-year-old woman with peri-implant tissue dehiscence regarding implants placed 20 years ago in a calvarial bone grafted maxilla and mandible was treated. Right maxillary and mandible peri-implants soft tissue were treated with a large apically positioned partial-thickness flap (APPTF) combined to a free gingival graft (FGG) simultaneously. For the left maxillary, where a frenum was in tension associated with infection and pockets, a large APPTF followed by a FGG 4 months later were performed. The KM width (KMW) increased in three operated sites with a gain average of 2.2 mm. The plaque control record decreased from 68% to 21%. All the probing depths were lower than 3 mm. Bleeding on probing was significantly reduced. The gingival index (GI) went from 1.5 to 0.25. Conclusion: In a multiple implants soft tissue dehiscence case, an APPTF associate to a FGG, delayed or not, seems to be a safety primary approach to improve the KMW and to stabilize the peri-implants soft tissue. Further, a connective tissue graft in a bilaminar approach could be an option to enhance soft tissue thickness and esthetic outcomes.