Lack of keratinized mucosa

Dear colleagues,
I would like to share this case with you:

a 59 year old female patient needs a prosthetic rehabilitation of implants 44 and 46.
Medical history: rheumatism, colitis and arthrosis, medication with cortisone.
There is a pronounced lack of keratinized mucosa.

How would you proceed?
1) Would you increase the width of keratinized mucosa?
2) What kind of graft would you use?
(FGG vs. CTS? autologous graft vs. collagen material?)
3) When would you do the treatment, in combination with abutment connection or separate?

Thank you very much for your comments!

Anja

27.04.2015, 08:21
FGG is a simple and fast method.
12.05.2015, 11:47
Dear Moustafa, thank you very much for your input and literature. I agree with your comment, increasing the width of the mucosa would not enhance the outcome of the implant. Still a more robust soft tissue is less sensitive and easier for the patient to clean, which might enhance the outcome on long term, don`t you think? In case you`d go for the surgery, which of the suggested techniques would you choose?
Thanks again! Anja
11.05.2015, 08:33
Thank you Anja for sharing this case:
I don't think that I need to increase the width of the keratinized mucosa in this case as in the literature there is neither evidence for the added health benefit of increasing the keratinized mucosa around dental implants nor about the superiority of certain technique for doing that.(1). This may unnecessarily increase treatment time and cost. I think the only reasons I may go for such added surgical procedure with CTG in the esthetic region where better pink esthetic and volume are needed.
(1)J Clin Periodontol. 2008 Sep;35(8 Suppl):83-6.Periodontal tissue engineering and regeneration: Consensus Report of the Sixth European Workshop on Periodontology.Palmer RM1, Cortellini P; Group B of European Workshop on Periodontology.
29.04.2015, 14:47