Interimplant Papilla Reconstruction Using the Iceberg and 'Garage' Connective Tissue Graft Technique: A Case Report and Technique Illustration

Abstract

A 45-year-old woman presented with a lack of interimplant papilla after a partially edentulous ante-rior area was rehabilitated with dental implants. The soft tissue phenotype and interimplant papilla were augmented using the 'iceberg' connective tissue graft (iCTG), followed by a second surgical procedure wherein a strip gingival graft was combined with a CTG inserted underneath a pouch prepared into the previous iCTG at the level of the crest (the garage approach), further enhancing soft tissue volume in that region. This technique aims to improve mucosal thickness and supra- crestal tissue height while addressing esthetic concerns associated with multiple implants placed in the anterior region. The final esthetic outcome was excellent and achieved harmonious soft tissue with appropriate thickness, symmetry with adjacent teeth, well-shaped interdental and interimplant papillae, and high patient satisfaction, making this approach a valuable addition to the surgical armamentarium. Future clinical studies are needed to evaluate the performance of this novel approach.

Keywords: connective tissue graft; implants; papilla; soft tissue augmentation.