Guided Peri-Implant Autogenous Soft-Tissue Grafting: A Case Report

This case report presents a proof of concept for a guided free gingival graft around a dental implant. A 65-year-old man presented to replace teeth Nos. 30 and 31. Once the osseointegration of the 2 implants placed by guided surgery had been achieved, a free gingival graft was indicated. The surgical planning of this graft was performed using cone-beam computerized tomography and arch digital scanning already used for implant placement. The greater palatine foramen and gutter were radiologically located to protect their arterial content. Two surgical guides were designed, one for the palatal donor site and one for the recipient site. The first one served both as an incision guide and as a postoperative protective plate. The procedure was free of adverse events. At the 1-year recall, the average gain in keratinized tissue width was 2.5 mm. This guided surgery could be used in a patient with insufficient amount of keratinized tissue around a posterior implant. For the first time, this procedure makes it possible to (1) anticipate, (2) accelerate, and (3) secure the surgical intervention. This technique can improve the practitioner's operative comfort and potentially the outcomes of free gingival grafts. Further research and clinical studies are needed to validate this protocol and to assess its long-term impact on peri-implant health.