CONTEMPORARY ESTHETIC PERIODONTICS
Figure 12 . Clinical intraoperative photograph showing the recipient bed around the teeth and in the pontic region
Figure 13 . Clinical intraoperative photograph showing the donor site ( right side of palate ). An outline was made with a new 15c blade
Figure 14 . Clinical intraoperative photograph showing the graft stabilized and immobilized via periosteal and single interrupted sutures
palate to create a band of attached keratinized gingiva and increase the vestibular depth . Witten informed consent for periodontal surgery was obtained from the patient . Case Management The attached keratinized gingiva is dense , resilient and tightly attached to the underlying tooth and bone , while the alveolar mucosa is thin , mobile , and apparently less capable of withstanding the functional stresses of mastication and oral hygiene practiced by the patient . The autogenous free gingival graft is a predictable surgical procedure to increase the width of keratinized attached gingiva , eliminate frenum and muscle pull , and to extend the vestibular depth depth 18 . After the administration of anesthesia to the
recipient site via local infiltrations on the buccal and palatal aspect of the maxillary right posterior region , periodontal curettes were used for subgingival debridement of the root surfaces of teeth # 16 & # 14 without damaging the crown margins , then the FPD was wiped with gauze soaked in 0.12 % chlorhexidine for 30 seconds . Subsequently , the recipient site ’ s epithelium , CT , and muscle fibers were sharply dissected down to the periosteum using 15c and 12 blades and microscissors to create a large recipient bed around the teeth and in the pontic region ( Fig . 12 ). Immediately after , a Free Gingival Graft was harvested from the right side of the palate using a new 15c blade ( Fig . 13 ). The graft was immediately transferred to the recipient site , which was stabilized and immobilized via periosteal and single interrupted sutures with 4.0 chromic gut sutures ( Fig . 14 ). Finally , tactile pressure was placed over the graft to remove any blood clots between the graft and recipient bed and to achieve close adaptation of the graft . No periodontal dressing was used to cover the graft and the patient was instructed to follow a liquid diet for the first 24 hours , followed by a soft diet for the remaining week and eat on the left side only . Patient was instructed to refrain from oral hygiene practices in the surgical site while rinsing with 0.12 % chlorhexidine gluconate ( three times daily ) for 2 weeks , take 500 mg Amoxicillin ( every 8 hours ) for 7 days and 800 mg Ibuprofen ( every 8 hours ) as needed for discomfort . The postoperative follow-ups were conducted at 1 ( Fig . 15 A & B ), 3 ( Fig . 16 A ), and 6 weeks ( Fig . 16 B ). Clinical Outcomes Healing was uneventful at both the donor and recipient sites . At the 1-week follow-up only visual examination was performed which revealed slight erythema and edema consistent with normal postsurgical healing and no swelling or infection was
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