case_images: PMC7396066_01
case_images: (a, b) Site of chief complaint revealing unsatisfactory aesthetic appearance.
case_images: CRID2020-3906468.001.jpg
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case_images: fig1
case_images: Due to the ridge defect and lack of soft-tissue quantity, the discrepancy in the location of the gingival margin was about 1 cm (Figure 1(a)).
case_images: Section from panoramic radiograph representing the site of chief complaint, prior to the attempted extraction of the left maxillary central incisor. Severe vertical bone defect around the left maxillary central incisor is evident.
case_images: CRID2020-3906468.002.jpg
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case_images: fig2
case_images: Flap is released (split-full-split) following coronally advanced flap design (as described by Zucchelli & De Sanctis).
case_images: CRID2020-3906468.003.jpg
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case_images: fig3
case_images: The flap design applied to manage this case is presented in Figure 3.
case_images: (a) Deepithelialized free gingival graft. (b) Connective tissue graft folded in two layers and then sutured, to gain soft-tissue thickness in the vertical direction.
case_images: CRID2020-3906468.004.jpg
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case_images: fig4
case_images: The first graft, harvested from the right palate, of about 20 mm in length (Figure 4(a)), was folded (Figure 4(b)), and then secured by two vertical mattress sutures, with 7/0 PGA sutures, to form a two-layered graft.
case_images: Folded connective tissue graft sutured at the defect site.
case_images: CRID2020-3906468.005.jpg
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case_images: fig5
case_images: The two-layered graft was sutured on the connective tissue of the occlusal side of the edentulous deepithelialized area, with a horizontal mattress suture and an interrupted suture, to secure the graft in place (Figure 5).
case_images: Second deepithelialized free gingival graft.
case_images: CRID2020-3906468.006.jpg
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case_images: fig6
case_images: Then, the second graft was harvested from the other side of the palate, which was of 20 mm length and 7 mm in width (Figure 6).
case_images: First part of the second deepithelialized free gingival graft sutured on the buccal side.
case_images: CRID2020-3906468.007.jpg
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case_images: fig7
case_images: This second graft was cut in two parts; the first part, which was about 13 mm in length, was sutured on the periosteum of the buccal side, with a horizontal mattress suture on the apical side and with a single interrupted suture on the first graft on the deepithelialized anatomical papillae (Figure 7).
case_images: Second part of the second deepithelialized free gingival graft.
case_images: CRID2020-3906468.008.jpg
case_images: PMC7396066_01_CRID2020-3906468.008.jpg
case_images: fig8
case_images: Sutured multilayered connective tissue graft (frontal view).
case_images: CRID2020-3906468.009.jpg
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case_images: fig9
case_images: Sutured multilayered connective tissue graft (occlusal view).
case_images: CRID2020-3906468.010.jpg
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case_images: fig10
case_images: Suturing of the flap.
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case_images: fig11
case_images: Single interrupted sutures, with 6/0 prolene, were performed to have a complete closure between the horizontal incisions of the edentulous area and the palatal island flap (Figure 11).
case_images: Healing after 6 months. Incomplete soft-tissue augmentation is evident.
case_images: CRID2020-3906468.012.jpg
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case_images: fig12
case_images: Due to incomplete soft-tissue augmentation, we performed a second mucogingival surgery, 6 months after the first one (Figure 12).
case_images: Probing depth after flap elevation.
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case_images: fig13
case_images: After split-thickness flap elevation, probing depth around the anterior maxillary teeth was 2 mm (Figures 13 and 14), which could mean that we might have a connective tissue attachment to the root surface of the right maxillary central incisor and the left maxillary lateral incisor.
case_images: The previous connective tissue graft augmentation is evident after flap elevation.
case_images: CRID2020-3906468.014.jpg
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case_images: fig14
case_images: After split-thickness flap elevation, probing depth around the anterior maxillary teeth was 2 mm (Figures 13 and 14), which could mean that we might have a connective tissue attachment to the root surface of the right maxillary central incisor and the left maxillary lateral incisor.
case_images: Sutured multilayered connective tissue graft (3 layers of occlusal connective tissue graft and one layer of buccal connective tissue graft).
case_images: CRID2020-3906468.015.jpg
case_images: PMC7396066_01_CRID2020-3906468.015.jpg
case_images: fig15
case_images: After the first part of the second graft was secured in place and was completely stable, the second part of the graft (which was about 7 mm length) was then sutured occlusally with two sling sutures around the right maxillary central incisor and the left maxillary lateral incisor (Figures 15 and 16).