Journal of Oral Implantology July 2014 - (Page 381)

CASE REPORT The ' Washing Line'' Suture Technique for Securing the Subepithelial Connective Tissue Graft Shane J. J. McCrea, MMedSci, MSc, BDS Following tooth extraction, resorption of the buccal wall of the socket will occur; this will be true for both the maxilla and the mandible. Where the extraction site is surrounded by natural dentition, the loss of the buccal alveolar plate can degrade the visual aesthetics of an implant-supported prosthetic rehabilitation. To aid the harmonization of the hard and soft tissue morphology, both hard and soft tissue augmentation can be carried out either consecutively with an extraction/immediate implant placement or prior to an implant placement in the delayed scenario. The contemporary method of increasing soft tissue volume is to use the Subepithelial Connective Tissue (auto) Graft (the SCTG). The graft requires fixation, otherwise it can be extruded from the recipient site. This article presents a novel suturing technique which can confidently secure the SCTG, thus resisting its dislodgement. Key Words: implantology, extraction, sutures, subepithelial connective tissue graft INTRODUCTION T he replacement of single or multiple teeth in an aesthetically sensitive zone is a major challenge. Tooth extraction results in both buccal soft and hard tissue remodeling that manifests itself as a reduction in volume morphology, that is, resorption. Bone resorption at a new extraction socket is continuous, with the greatest amount occurring within the first month. Pietrokovski et al1 studied 123 human edentulous dry bone specimens, concluding that in the maxilla, bone resorption was centripetal and apical, that is, bone resorption was overwhelmingly from the buccal surface of every socket with significantly reduced resorption from the palatal aspect of the socket. In the mandible, resorption was centrifugal and apical, forming an edentulous crest central to the former tooth sockets. This difference in resorption produced a reverse horizontal overlap of the residual crests, with the edentulous maxilla at the same level The Dental Implant and Gingival-Plastic Surgery Centre, Bournemouth, Dorset, UK. Corresponding author, e-mail: shanemccrea@aol.com DOI: 10.1563/AAID-JOI-D-12-00069 or internal to the facing edentulous mandible.2 Over time, the degree of resorption is directly related to a decrease in the aesthetic value achieved with dental implant replacement surgery. Both bone and soft tissue grafting techniques have been developed to address the loss in tissue volume. The subepithelial connective tissue graft (SCTG) is frequently used at periodontal recession sites to increase the volume of soft tissue at a deficient site and also convert ''thin'' periodontal phenotype A3,4 into a stable ''thick'' gingival phenotype B. Bashutski and Wang5 having reiterated the importance of tissue thickness and transferred the concepts to implant treatment planning. Current understanding is geared toward establishing a thick tissue biotype around implants because of its contribution to the aesthetic result of an implantsupported restoration. A thick biotype resists recession,6,7,8 is able to better conceal titanium,9 and helps maintain gingival morphology.16 Thus, thick biotype is preferred to thin biotype around dental implants. Evans and Chen17 performed a study on immediate implants, defining biotype by probe transparency. The study found that periimplant marginal stability was dependant on the baseline tissue thickness: Increasing soft tissue thickness minimizes the potential for peri-implant Journal of Oral Implantology 381

Table of Contents for the Digital Edition of Journal of Oral Implantology July 2014

Upcoming Enhancements to the Publishing Process
Enhanced Osteoblast Proliferation and Corrosion Resistance of Commercially Pure Titanium Through Surface Nanostructuring by Ultrasonic Shot Peening and Stress Relieving
An Interocclusal Recording Method for the Fabrication of Full-Arch Implant-Retained Restorations
Classification of the Alveolar Ridge Width: Implant-Driven Treatment Considerations for the Horizontally Deficient Alveolar Ridges
Repair of a Multiple Implant-Supported Fixed Superstructure With a Metal-Ceramic Resin- Bonded Fixed Partial Denture: A Clinical Report
Postoperative Perforation of the Schneiderian Membrane in Maxillary Sinus Augmentation: A Case Report
The ‘‘Washing Line’’ Suture Technique for Securing the Subepithelial Connective Tissue Graft
Trephine Core: An Alternative Sinus Lift Technique
Second Harvest of Mandibular Ramus Blocks in Bone Augmentation Procedures: A Case Letter
Piezosurgery Applied to Implant Dentistry: Clinical and Biological Aspects

Journal of Oral Implantology July 2014