Tunneling with conjunctival graft for volume increase peri-implant: case report
Authors: Da Silva Paula Jéssica , Canuto Gonçalves da Silva Juliano , Alves do Nascimento Jaqueline , Andrade Gonzaga de Oliveira Antônio Jackson , França Araripe Cariri Tiago , Lucena de Vasconcelos John Eversong 
Published: August 2020

Introduction: The technique of tunneling connective graft has made it to recover defective vestibular volume, since it does not compromise aesthetics; it also gives the patient the function of the damaged area. Objective: The present study aims to report a case of tunneling with connective graft to increase peri-implant volume. Case Report: A 53-year-old female leucoderma sought a private clinic with complaint of pain, aesthetic dissatisfaction of element 11 and that had already had endodontic retreatment of the element in question and paraendodontic surgery, but without success. After performing the clinical examination and computed tomography, there was a paraendodontic lesion and little vestibular thickness and reabsorption of the cortical bone. In the planning, we opted for exodontic the element 11 and implant placement immediately. After healing, the need soft tissue grafting in the peri-implant region was observed to for vestibular volume increase. Final Considerations: it's corroborated that the technique of connective graft tunneling for soft vestibular soft tissue remodeling and new arrangement  are excellent reconstructive technique, since it does not allow relaxing incisions, making it impossible to have scars.Descriptors: Connective tissue; Dental Implant; Grafts.ReferencesFaverani LP, Fereira GR, Gaetti-Jardim EC, Okamoto R, Shinohara EH, Assunção WG, Rangel Junior IR. Implantes osseointegrados: evolução e sucesso. Salusvita. 2011;30(1):47-58.Serrilho RP, Tolentino LS, Frare JG, Souza Pinto GN. Enxerto de tecido mole como opção para suprir defeitos peri-implantares. Relato de caso clínico. Rev Assoc Paul Cir Dent. 2015; 69(4):350-54.Thoma DS, Naenni N, Figuero E, Hammerle CHF, Schwarz F, Jung RE et al. Effects of soft tissue augmentation procedures on peri- implant health or disease: a systematic review and meta- analysis. Clin Oral Implants Res. 2018;29(Suppl 15):32-49. Giannobile WV, Jung RE, Schwarz F; Groups of the 2nd Osteology Foundation Consensus Meeting. Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health. Clin Oral Implants Res. 2018;29(Suppl 15):7-10.  Zuhr O, Rebele SF, Cheung SL, Hürzeler MB; Research Group on Oral Soft Tissue Biology and Wound Healing. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000. 2018;77(1):123-49.Xavier I, Alves R. Enxerto de tecido conjuntivo tunelizado – a propósito de um caso clínico. Rev port estomatol med dent cir maxilofac. 2015;56(4):256-61.Fiorin LG, Novaes VCN, Rinaldi H, Gusman DJR, Araujo NJ, Almeida JM et al. Enxerto de tecido conjuntivo subepitelial tunelizado em área periimplantar deficiente em mucosa queratinizada. Arch Health Invest 2017;6 (Spec Iss 2):154.