Fifteen-Year-Old Lower Implants with a Painful Sore, Treated with a Free Gingival Graft
Lower implants placed fifteen years earlier, with no firm gum around them. A denture had rubbed a painful sore against one implant and could not be worn. A free gingival graft built a thick band of attached tissue and deepened the vestibule. Photographed at two weeks.
What the Patient Noticed
Severe pain from an ulcer where the lower denture rubbed against an implant, to the point that the denture could not be worn. The implants had been placed fifteen years earlier and were sound, but the tissue around them was thin, loose, and movable. Thin, movable tissue around an implant is harder to keep clean and more easily irritated by an appliance resting on it. On what adding firm tissue achieves, the systematic review and network meta-analysis by Tavelli and colleagues in the Journal of Periodontology found that widening the band of keratinized tissue around implants was associated with significant reductions in probing depth, plaque, and soft tissue dehiscence. Whether a narrow band by itself causes disease is less settled; what was not in doubt here was that this patient could not wear her denture.
What Was Done
A free gingival graft: a piece of the surface tissue of the palate was placed around the implants to create a wide band of keratinized, attached gum, and the vestibule (the fold between gum and lip) was deepened so the denture has room. Implant problems covers the other reasons an older implant gives trouble.
The Result
At two weeks there is a thick, pale band of firm tissue around the implants and a deeper vestibule. The sore is healed and the denture can be worn again. Free gingival grafts look pale at first and darken toward the surrounding tissue over the following months, though they often stay somewhat lighter than the gum around them.