Method of extracorporeal fixation of partially laser-de-epithelialized free gingival graft with non-impact pins with a wide head during dental implantation

Abstract

A method of extraosseous fixation of a partially laser-de-epithelialized free gingival graft with wide-headed impact-free pins during dental implantation, including rinsing the mouth with a 0.05% solution of chlorhexidine bigluconate for 15-30 seconds before surgery, followed by infiltration anesthesia with Sol. «Articaini» 4% 1.7 ml with adrenaline 1:200000, after which the dental implant is installed in compliance with the manufacturer's protocol and taking into account the clinical case, where a free gingival graft is taken from the hard palate using a #15C scalpel, which corresponds to the size of the defect, then the graft is partially de-epithelialized using an erbium laser «LiteTouch» (Israel), in the soft tissue mode, energy and pulse frequency of 100 mJ × 10 Hz using the recommended nozzle 1.3 × 14 mm or 1.3 × 17 mm, cooling settings, air and water supply (level 5),the multilayered squamous keratinized epithelium has a thickness of 300 μm, where the laser flash evaporates a layer of 150-200 μm, in a circular motion at a speed of 3-5 mm / s, to perform de-epithelialization, it is carried out in 1 pass over the entire surface of the graft, which allows you to prepare it with minimal loss in volume, at the beginning, place the tip perpendicular to the graft from the epithelial side, continuously moving it over the surface, while it is necessary to limit yourself to partial removal of the epithelial layer of the free gingival graft, and water-air spraying provides better visibility of the treatment zone, after which the free graft is fixed to the recipient zone with the partially de-epithelialized side to the bone tissue using titanium impact-free pins with a wide head, a plug is fixed to the dental implant (if primary stability is not achieved), a multi-unit, a gingival cuff former or a provisional structure,The mucoperiosteal flap is repositioned and sutured with Monoquik 5.0 interrupted sutures. After surgery, the patient is recommended to take oral baths with 0.05% chlorhexidine bigluconate solution twice a day for 7 days. The sutures are removed on the 10th to 14th day, and the titanium pins are removed after 1 to 2 months through a low-traumatic puncture of the mucous membrane. Then, after 3 to 4 months, permanent prosthetics are performed.