Gingival Graft? 

Forty-five-year-old Spanish man has lost the teeth #7 and 8 for 2 years (due to caries, Fig.1,2) with localized buccal plate atrophy (Fig.1-3 *).  Wax-up (Fig.4) shows that implant supported crowns will look longer than their counterparts (#7,8 vs. 9,10).

CBCT with surgical stent shows that it is possible to place 4x17 and 4.5x17 tapered implants for the sites #7 and 8 with bone expansion, respectively (Fig.5 coronal section, Fig.6 axial (at the level of 16.4 mm line in Fig.5), Fig.7, 8 sagittal across the site #7 and 8, respectively).

To improve esthetic results, is gingival graft needed prior to, at the same time of or after implant placement?

Since bone buccolingual width is mildly to moderately atrophic, two implants can be placed at the same time with minimal bone expansion?

Xin Wei, DDS, PhD, MS 1st edition 11/16/2011, last revision 12/27/2011