Editorial Type:
Article Category: Other
 | 
Online Publication Date: 01 Aug 2014

Clinical Study of Flap Design to Increase the Keratinized Gingiva Around Implants: 4-Year Follow-Up

MD, DDS,
MD, MS,
MD, and
MD, DMD, PhD
Page Range: 459 – 464
DOI: 10.1563/AAID-JOI-D-11-00236
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Since the presence of keratinized gingiva is so important for peri-implant outcome, the aim of this study is to describe a partial thickness flap design to increase the amount of keratinized peri-implant tissue as well as its thickness. A total of 131 implants were placed in 85 patients: 103 implants (78.63%) in the mandible and 28 implants (21.37%) in the maxilla. Before implant placement in edentulous ridge the residual keratinized mucosa usually was measured with a periodontal probe in a buccal–palatal direction. A palatal or lingual incision was made to raise a partial thickness flap with the residual keratinized tissue. After implant placement the flap was apically repositioned and secured with loose periosteal sutures. Keratinized tissue levels were calculated at baseline, at 6 months, and every year follow-up. Measurements were reported for each implant diameter. At 4-year follow-up, implant survival rate of 87.79% was reported. Peri-implant keratinized mucosa confirmed clinical gain in all cases; mean levels at 1- and 4-year follow-ups were 7.26 ± 2.01 mm and 7.37 ± 2.12 mm, respectively. The levels remained stable over time. This flap design allows immediate correction of adaptation of the keratinized tissue around the implant, increasing the thickness and amount of the keratinized tissue.

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  <sc>Figure</sc>
  1.
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Figure 1.

(a) Preoperative radiograph. (b) Clinical photograph showing the edentulous ridge of the mandible with keratinized mucosa situated at the bone crest level.


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  <sc>Figure 2.</sc>
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Figure 2.

(a) Exposure of the crest with the partial-thickness flap. (b) Clinical photograph showing final preparation of implant sites. (c) Clinical photograph of implant placement. (d) The buccal flap was then adapted around the lateral borders of the healing abutment and apically repositioned and secured with loose periosteal sutures. (e) Healing of keratinized mucosa around abutments 3 months later.


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  <sc>Figure 3.</sc>
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Figure 3.

(a) Clinical photograph showing final restoration and the maintenance of keratinized gingival tissue after 4-year follow-up. (b) Periapical radiograph performed 4 years later.


Contributor Notes

Corresponding author, e-mail: robcresp@libero.it
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