Buccally displaced Flap-A novel surgical approach to increase keratinized tissue in implant uncovering-technique and clinical evaluation

15801 ORAL COMMUNICATION CLINICAL INNOVATIONS

Background

An adequate zone of keratinized mucosa (KM) influences the overall long-term success of implant-supported oral rehabilitation. Proper soft tissue anatomy enables adequate maintenance and thicker tissues protect from bacterial invasion and are less likely to recede. A novel surgical technique based on displacing the flap buccally to increase the KM around implants at the time of implant uncovering has been described.

Aim/Hypothesis

The aim of this study was to describe and evaluate a novel surgical approach for implant uncovering, the goal of which was to augment the buccal peri-implant KM, by using a partial thickness buccally displaced flap.

Material and Methods

Two-stage bone level endosseous implants placed in the posterior region (premolar molar) with adequate bone dimensions were included in this prospective pilot study. 8 weeks after implant placement, the subjects were randomly allocated to-Group A (Soft tissue augmentation using buccally displaced flap) or Group B (subepithelial connective tissue graft). For Group A, two parallel vertical incisions were given extending 4 mm on the palatal lingual side and joined with a perpendicular incision. Partial thickness flap was reflected and displaced 2–3 mm buccally depending on the required augmentation. A tissue punch was created to engage the gingival former through the flap to the implant. For Group B, a pouch was created buccally and subepithelial connective tissue graft was tucked in. Gingival former was placed and the flap along with the graft was sutured. The width (WKM) and thickness (TKM) of the KM was measured prior to the implant uncovering, 4 weeks and 1 year after implant loading.

Results

A total of 14 implants placed in 10 subjects (2 males, 8 females; mean age 51.3 years) were included in this study. All implants were clinically stable and had no signs of peri-implant disease. The WKM averaged at 1.15 mm and 1.09 mm for Groups A and B prior to the second stage surgery showing no statistically significant difference (P = 0.21). 4 weeks and 1 year after implant loading, the WKM was significantly increased in both groups as compared to the baseline and showed significantly higher values for group B (3.62 mm, 3.34 mm) as compared to group A (3.14 mm, 3.05 mm) (P = 0.003). The mean TKM for groups A and B prior to the second stage surgery was 1.42 mm and 1.39 mm respectively (P = 0.17). 4 weeks after implant loading, the TKM was significantly higher for group B (2.43 mm) as compared to group A (2.27 mm) (P = 0.002). However, 1 year after implant loading, TKM did not show significant difference between group A (2.22 mm) and group B (2.29 mm) (P = 0.11).

Conclusion and clinical implications

The presented surgical procedure aimed at increasing the KM around implants. The main benefits were predictability, suitable vascularization, non-necessity of sutures and reducing number of surgical interventions and sites. Within the limitations of this study, it was seen that this technique increased the width and thickness of KM around implants, which was comparable to the gold standard of subepithelial connective tissue graft, and may be employed to augment the KM during implant uncovering.