Is Bone All That Matters for Implants? Extending Implant Longevity by Creating Firm Gum Tissue (FGG / Vestibuloplasty)

### **1. Before Treatment (Diagnosis)** This patient had been missing the lower right molars for an extended period before visiting our clinic. As you can see, the alveolar bone had significantly atrophied, and most importantly, there was **virtually no firm, attached gingiva around the implant site.** If an implant is placed in this condition without addressing the soft tissue, brushing becomes painful, food constantly gets trapped, and the patient faces a very high risk of developing **peri-implantitis** down the road.

Before treatment: Alveolar bone has receded and attached gingiva is severely lacking due to long-term tooth loss.

### **2. Implant Placement and Gum Graft (Second-Stage Surgery)** Two months after the implant fixture was placed, we performed second-stage surgery combined with **free gingival graft (FGG)** and **vestibuloplasty** to reinforce the deficient gum tissue. - **Vestibuloplasty:** Deepens the shallow gingival sulcus to reduce food impaction. - **Free Gingival Graft (FGG):** Harvests firm gum tissue from the palate and transplants it around the implant, creating a protective barrier.

FGG and vestibuloplasty performed simultaneously with second-stage implant surgery.

### **3. Healing Process (1–2 Weeks)** This is the healing phase as the grafted tissue integrates with the surrounding tissue. Some discomfort is expected immediately after surgery, but over time the transplanted gum fuses with the adjacent tissue and establishes a stable blood supply.

Healing progress: From the day after surgery through two weeks — the grafted tissue integrating stably.

### **4. Custom Abutment Connection** After the gum tissue had fully healed, a **custom abutment** precisely matching the patient's gum contour was connected. If you look at the arrow area (buccal gum), you can see that a **thick, firm band of gum tissue** — absent before surgery — now firmly surrounds the implant.

Prosthetic connection stage: The FGG graft has firmly integrated on the buccal (cheek-side) aspect of the implant.

### **5. Provisional and Final Prosthesis** A provisional crown was used to test chewing function and gum adaptation, followed by the final **zirconia crown** for long-term durability.

Treatment complete: A sturdy zirconia prosthesis with a deepened vestibule.

### **Dr. Kang's Commentary: Why Undergo a Difficult Gum Surgery?** Comparing the before and after photos, you can see the **newly formed deep vestibule and firm attached gingiva** beneath the prosthesis.

Implants have weaker bacterial defense than natural teeth. While it may be a more demanding process, **fundamentally improving the soft tissue environment** is what allows an implant to function trouble-free for 10 or 20 years. "Rather than placing it fast, placing it to last." This is the steadfast treatment philosophy of TTE Dental Clinic.