Subperiosteal circumferential connective tissue graft for vertical implant soft tissue augmentation

Abstract Background Vertical implant soft tissue augmentation is indicated to optimize esthetic outcomes in cases of peri‐implant soft tissue deficiency or dehiscence, particularly when the peri‐implant mucosa is exposed during a full smile. This manuscript describes the use of a subperiosteal circumferential connective tissue graft (SC CTG) for vertical implant soft tissue augmentation via the vestibular incision subperiosteal tunnel access. Methods A 78‐year‐old Caucasian female presented with peri‐implant soft tissue deficiency at unrestored implants #7 and #8, with peri‐implant mucosal margins visible during a full smile. Vertical implant soft tissue augmentation using a SC CTG was performed initially on both implants #7 and #8, and on implant #8 alone 6 weeks later. Four weeks after the second augmentation, the implants were provisionalized, and definitive restorations were delivered 8 months thereafter. Results The peri‐implant mucosa at both implants appeared pink, firm, stippled, and well adapted to the restorations. Mucosal display at implants #7 and #8 during a full smile was comparable to and harmonious with the contralateral dentition. The patient reported satisfaction with the esthetic outcome. Conclusions The SC CTG, featuring perforations created with a tissue punch to permit passage of the healing abutments, enabled graft stabilization solely by the abutments and facilitated circumferential enhancement of the peri‐implant mucosal phenotype without the need for sutures when applied via the vestibular incision subperiosteal tunnel access. Within the limitations of this case report, this approach appears to be a simple, effective, and sutureless technique for vertical implant soft tissue augmentation. Key points The subperiosteal circumferential connective tissue graft (SC CTG), featuring a tissue punch‐created perforation for healing abutment passage, enables graft stabilization by the abutment alone and facilitates circumferential enhancement of the peri‐implant mucosal phenotype. For optimal outcomes, the SC CTG should be stabilized with a narrow healing abutment or a restoration with narrow submucosal contours to maximize circumferential tissue gain and enhance peri‐implant tissue stability. The thickness and dimensional stability of the SC CTG are key determinants of vertical soft tissue gain.