J Periodontal Implant Sci.  2010 Aug;40(4):194-200.

A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases

• Park JC
• Yang KB
• Choi Y
• Kim YT
• Jung UW
• Kim CS
• Cho KS
• Chai JK
• Kim CK
• Choi SH

Abstract

PURPOSE
There is no consensus regarding the relationship between the width of keratinized mucosa and the health of peri-implant tissues, but clinicians prefer to provide enough keratinized mucosa around dental implants for long-term implant maintenance. An apically positioned flap during second stage implant surgery is the chosen method of widening the keratinized zone in simple procedures. However, the routine suture techniques used with this method tend to apply tension over the provisional abutments and decrease pre-existing keratinized mucosa. To overcome this shortcoming, a pre-fabricated implant-retained stent was designed to apply vertical pressure on the labial flap and stabilize it in a bucco-apical direction to create a wide keratinized mucous zone.
METHODS
During second stage implant surgery, an apically displaced, partial thickness flap with a lingualized incision was retracted. A pre-fabricated stent was clipped over the abutments after connecting to the provisional abutment. Vertical pressure was applied to displace the labial flap. No suture was required and the stent was removed after 10 days.
RESULTS
A clinically relevant amount of keratinized mucosa was achieved around the dental implants. Buccally displaced keratinized mucosa was firmly attached to the underlying periosteum. A slight shrinkage of the keratinized zone was noted after the healing period in one patient, but no discomfort during oral hygiene was reported. Clinically healthy gingiva with enough keratinized mucosa was achieved in both patients.
CONCLUSIONS
The proposed technique is a simple and time-effective technique for preserving and providing keratinized tissue around dental implants

Keyword

Dental esthetics; Dental implants; Gingiva

MeSH Terms

Consensus
Dental Implants
Esthetics, Dental
Gingiva
Humans
Keratins
Mucous Membrane
Oral Hygiene
Periosteum
Stents
Suture Techniques
Sutures
Dental Implants
Keratins

Figure

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  Figure 1 Radiographic photo after first stage implant surgery.

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  Figure 2 Clinical photo taken 4 months post-implantation. There was a decreased keratinized mucous zone and the buccal side of #31 was partially covered with mucosa.

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  Figure 3 After lingualized incision and retraction of the partial thickness flap, the implant fixture was uncovered.

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  Figure 4 Clinical photograph and three dimensional schematic drawing of the pre-fabricated implant-retained stent.

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  Figure 5 The stent was stabilized over the healing abutment. Additional sutures were placed on the mesial and distal side.

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  Figure 6 Clinical photo taken 1 month post-surgery. Slight shrinkage of the keratinized mucous zone was noted.

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  Figure 7 The final restoration was seated 3 months post-surgery. The apically positioned keratinized mucosa was well maintained.

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  Figure 8 Clinical photo of the implant area (A) before first stage implant surgery and (B) 4 months after first stage surgery. (C) Clinical photo of the provisional abutment connection with pre-fabricated implant-retained stent and (D) 2 months after second stage surgery.

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  Figure 9 Comparison of two techniques using an apically positioned flap (APF) with a partial thickness flap around the dental implants. (A) Periosteal and vertical line sutures. Dead space is created under the displaced flap and sutures are difficult and time-consuming. (B) The prefabricated implant-retained stent in the APF with partial thickness flap. Dead space is eliminated by vertical pressure from the stent, and no suture is required on vertical incisions.

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