Very often, both in practice and in training, we focus on bone reconstruction but skip over what should be a fundamental component of the reconstructive procedure: the reconstruction of the keratinized adherent tissue.
This will be the real barrier that will protect our patient’s implants in the long term, especially if they are surrounded by regenerated bone in a risky area such as the posterior mandible.
In my opinion, soft tissue reconstruction is far more important than hard tissue reconstruction.
Having an implant with two or three coils outside the bone but nice gingival tissue is far better than having an implant immersed in reconstructed bone but without nice marginal gingival tissue. Obviously, having both is the best!!!
So let’s see how we can schematize the reconstruction of the keratinized tissue in a posterior mandibular reconstructed site in three steps, which we can carry out at the same time as uncovering the implants placed 3 months earlier…
The second step is to take a flap of connective epithelium tissue from the palate.
Obviously, looking for keratinized tissue where this has often disappeared either due to previous resorption or due to subsequent bone regeneration procedures, we will have to take tissue from a well-keratinized area and the palate is definitely the best donor site.
When I need only connective tissue, I always use the tuber maxillae, but if we need an extensive connective epithelium flap, we will hardly find a sufficiently extended tuber.
Let’s see the procedure on video… as YouTube censors violent images, you will have to be logged in with your YouTube account to see it.