Surgical Grafting with Veneers. Part 1

 Surgical and Restorative SVG Protocol


The aim of the procedure was to stop changing of the buccal contours after teeth extraction. Then augmentation of periimplant soft tissue thickness was needed. The matter concerned those tissues that were coronal to the abutment interface.


It was also recommended to assess the width of the tooth that was supposed to undergo extraction as well as of the adjacent teeth. Thus, nontraumatic tooth extraction was possible, no lift of the flap was needed. The blood supply was supposed to continue and go to the labial bone plate. In the specified case the socket must be removed accurately, then the implant is placed palatally. Preliminary, CBCT should be done. The implant must be positioned 3-4mm apically to the free gingival margin. There should be also 1.5mm to the teeth that are adjacent to the implant. Otherwise, the labial plate dehiscence will take place and the adjacent teeth attachment will be lost. This will also provide enough of the vertical space for prosthetic component development.


Stability is provided due to geometry of the implant. Hand torque is also needed, of not less than 35 Ncm. Thus, immediate restoration of the contours will be done. Filling anterior sockets with palatal implants often causes insufficient contact of the facial bone and implant. It is called a gap.


After the palatal tissue thickness and state are duly assessed, the graft is positioned with first-intention or second-intention healing technique utilization. As for the protocol, 1mm thickness of connective tissue graft is needed. What thickness of the palatal tissue is, will be shown after the needle for anaesthesia is penetrated. The most appropriate donor area is distal to the 1st molar and the 2nd bicuspid. A bone graft, dual-zone one, is put into the gap serving  for maintenance of the soft tissue volume and blood clotting, which is needed for healing. Then, at the very end, a screw-retained restoration is placed. It serves as a socket-healing tool. It protects, comprises, and maintains blood clot at the healing phase. In addition, mechanical support of the periimplant soft tissues is provided.