Mauricio Gutierrez, DMD, MS

Buccal contour grafting and soft-tissue socket seal at the time of immediate implant placement to prevent framework collapse following extraction. Tuberosity micro-graft harvesting for buccal contour graft and palatal ‘biopsy harvest’ of epithelialized CTG plug. Straumann Bone Level NC implant. Framework support with removable prosthesis with ovated pontic. Looking forward to a beautiful final outcome with Caryn Kleiman D.D.S., M.S.

Extraction and immediate implant. BioHorizon Tapered Pro Conical. Contour CTG graft. BH Smart Shape Healer.

Less can be more. This case is a great example of what can be done with smaller volumes of dense connective tissue harvested from the tuberosity. Tuberosity tissue is found in less in quantity than palatal tissue but is much better quality. Maxillary tuberosity grafts are much richer in dense lamina propria (fibrous connective tissue) and have none of the glandular and adipose elements common in palatal harvests. All it takes is a little more patience for proper harvesting and filleting technique (whale tail filet seen in this cases)

Hard Sost Tissue Regeneration on a 16 yr old patient with congenitally missing lateral incisors prior to bonded Zi bridge. Plan is for implants once the patient has completed maxillofacial growth. With that goal in mind, the horizontally deficient alveolar bone was grafted with BioOss Collagen (Mineralized Xenograft) and FibroGide (Soft Tissue Xenograft). Ovate pontic development including gingivoplasty #7 by the talented Dr. Caryn Kleiman prior to finalizing case with unilaterally-boded RBR’s 6-x,x-11.

Soft tissue ridge augmentation of a combined (vert/horiz) alveolar defect...Part 1

History of failed implants (infection) and compromised bone. Part II to include additional grafting as well as esthetic crown lengthening #8.
Part III - ovate tissue development.

Staged Mucogingival Rehab Part II - Six months after anterior grafting (see previous post), the patient is ready to proceed with posterior grafting prior to replacement of existing crowns. Bilateral tuber harvesting for CTGs. Adjunctive Emdogain

25-year-old patient was referred to me for an implant to replace a congenitally missing #10 with severe apical resorption on #9. Given the patient’s young age, the tight spacing on #10, the guarded prognosis for #9, and favorable occlusion, I suggested changing the treatment plan to a unilateral bonded zirconia bridge (X-11).

Soft tissue ridge augmentation with a dual tuberosity graft was performed. After three months of healing, she is finally ready for a fixed permanent restoration.

With advances in adhesive dentistry, I am a strong proponent of delaying the placement of implants in tight lateral spaces. In this case, if/when she loses #9 in her 3rd or 4th decade of life, the 9 site will be a much better implant site with a cantilevered pontic on 10. Thoughts?

Often used as a harvest site for connective tissue, the maxillary tuberosity can also be used as a source of epithelium for a small free gingival graft. With significant less innervation than the palate, harvesting an FGG from the tuberosity significantly reduces post-operative discomfort for the patient.