ALVEOLAR RIDGE AUGMENTATION BY SUBEPITHELIAL CONNECTIVE TISSUE GRAFTING TO IMPROVE AESTHETIC ORAL REHABILITATION (Atena Editora)

Abstract

Introduction: Defects in the alveolar bone ridge in edentulous areas may result from extraction procedures or pathologies, compromising function and aesthetics. Pre-prosthetic surgery for the purpose of ridge augmentation commonly uses soft tissue graft techniques in cases where volume loss occurred in the buccolingual width, and the association of bone grafts when there is loss in height. Objective: To report a clinical case of subepithelial connective tissue grafting to increase the ridge in the anterior maxillary region in a female patient, 21 years old, with aesthetic and functional complaints due to cortical bone resorption resulting from localized periodontitis and tooth loss. Methods: After obtaining free and informed consent from the patient, diagnostic and prognostic considerations of the case were carried out. The initial therapy related to the cause included the creation of a temporary fixed prosthesis, which also served as a post-surgical conditioner. The surgical technique consisted of preparing the graft recipient bed, on the edge of the region of the upper right central incisor, with a linear incision located palatal to the defect site, extending in the division of a partial thickness flap parallel to the buccal cortex and exceeding the limit of the mucogingival junction. The graft was obtained from a donor area in the palatal region of the right upper premolars and first molar, with a linear incision 3 mm away from the gingival margin. A wedge of tissue with a conjunctival thickness of 2 to 3 mm was obtained through two internal bevel incisions and transplanted to the recipient bed. The synthesis was performed using simple interrupted sutures with an atraumatic needle and nylon monofilament thread in the donor area of the graft and, in the recipient bed, the vestibular flap was brought closer to the limits of the palatal inserted mucosa, crossing the thickness of the graft. The postoperative period included analgesic and anti-inflammatory prescriptions, cleaning with a post-surgical toothbrush and mouthwash with chlorhexidine digluconate for 14 days. Results: Post-operative clinical-radiographic monitoring revealed that the patient's functional and aesthetic discomfort was resolved by the recovery of the planned tissue dimension and by morphological conditioning with the formation of an interdental papilla during the provisional prosthetic phase. Conclusions: An important requirement for the success and predictability of ridge augmentation procedures with subepithelial connective tissue graft is to analyze the degree of loss in buccolingual width and height. The reported case, of precise indication in a moderate defect of a single tooth, achieved reconstruction of the volume of lost tissues with predictability and functional and aesthetic benefits.