Labial overlay cervical composite for containment of partially exposed connective tissue graft.

Background: Placement of a connective tissue graft (CTG) in the facial abutment‒socket gap without any flap/pouch preparation has been demonstrated to effectively increase mucosal thickness and maintain midfacial marginal stability. At sites where the mucosal margin must be coronally advanced to improve esthetics, a flapless/pouchless approach requires the graft to be left partially exposed, which increases the risk of graft necrosis. The purpose of this report is to introduce the labial overlay cervical composite (LOCC) to provide graft containment and stabilization in these challenging situations to improve graft survival.

Methods: A 67-year-old healthy, nonsmoking, Caucasian female presented with tooth #10 having external resorption that had progressed to the pulp, and the gingival margin 3‒4 mm apical to the gingival margin of the contralateral incisor. The tooth was extracted, and an immediate implant was placed flapless. The provisional restoration was fabricated ∼2 mm short of the mucosal margin. The implant‒socket gap was grafted with bone, and the abutment‒socket gap was grafted with a CTG, which was ∼2 mm exposed. The LOCC was fabricated by bonding flowable composite to the midfaciocervical surface of the provisional crown and extending it apically to cover the graft.

Results: The exposed CTG covered by the LOCC survived. Twenty-one months post-treatment, the midfacial mucosal margin remained consistent with the contralateral gingival margin, and the convex facial tissue contour was preserved.

Conclusion: The LOCC may effectively enhance graft survival and overall esthetic outcome when the CTG must be left exposed by providing containment and stabilization of the graft.

Key points: Labial overlay cervical composite (LOCC) is a simple addition to the provisional crown during treatment and can be easily removed during post-op. LOCC may effectively enhance graft survival and overall esthetic outcome when the connective tissue graft must be left partially exposed by providing containment and stabilization of the graft.

Plain language summary: A patient needed to have an upper left front tooth replaced with a dental implant. The gumline of the tooth to be replaced was 3‒4 mm higher than the gumline of the same tooth on the right side. The patient wanted the gumline from both sides to match. The tooth was extracted, and an implant was placed on the same day. The gap between the implant and tooth socket was grafted with bone from the bottom of the socket to the top of the implant, and a gum graft above the implant. The gum graft was partially sticking out so that the gumlines would match. A temporary crown was made and attached to the implant. To prevent the gum graft from dislodging, a labial overlay cervical composite (LOCC) was added to the temporary crown to cover and contain the gum graft. The treatment was successful. Twenty-one months after treatment, the gumline of the implant on the left side matched the gumline of the tooth on the right side. The LOCC may effectively enhance graft survival and overall esthetic outcome when the gum graft must be left partially exposed by providing containment and stabilization of the graft.