Subperiosteal circumferential connective tissue graft for vertical implant soft tissue augmentation.

BACKGROUND: Vertical implant soft tissue augmentation is indicated to optimize esthetic outcomes in cases of peri-implant soft tissue deficiency or dehiscence, particularly when the peri-implant mucosa is exposed during a full smile. This manuscript describes the use of a subperiosteal circumferential connective tissue graft (SC CTG) for vertical implant soft tissue augmentation via the vestibular incision subperiosteal tunnel access. METHODS: A 78-year-old Caucasian female presented with peri-implant soft tissue deficiency at unrestored implants #7 and #8, with peri-implant mucosal margins visible during a full smile. Vertical implant soft tissue augmentation using a SC CTG was performed initially on both implants #7 and #8, and on implant #8 alone 6 weeks later. Four weeks after the second augmentation, the implants were provisionalized, and definitive restorations were delivered 8 months thereafter. RESULTS: The peri-implant mucosa at both implants appeared pink, firm, stippled, and well adapted to the restorations. Mucosal display at implants #7 and #8 during a full smile was comparable to and harmonious with the contralateral dentition. The patient reported satisfaction with the esthetic outcome. CONCLUSIONS: The SC CTG, featuring perforations created with a tissue punch to permit passage of the healing abutments, enabled graft stabilization solely by the abutments and facilitated circumferential enhancement of the peri-implant mucosal phenotype without the need for sutures when applied via the vestibular incision subperiosteal tunnel access. Within the limitations of this case report, this approach appears to be a simple, effective, and sutureless technique for vertical implant soft tissue augmentation. KEY POINTS: The subperiosteal circumferential connective tissue graft (SC CTG), featuring a tissue punch-created perforation for healing abutment passage, enables graft stabilization by the abutment alone and facilitates circumferential enhancement of the peri-implant mucosal phenotype. For optimal outcomes, the SC CTG should be stabilized with a narrow healing abutment or a restoration with narrow submucosal contours to maximize circumferential tissue gain and enhance peri-implant tissue stability. The thickness and dimensional stability of the SC CTG are key determinants of vertical soft tissue gain.