Background:
The presence of an adeguate width of keratinized gengiva around implants is an essential condition for long maintenance of implant health. That condition achieve more natural perimplant prostetic profiles, a more easy cleneability, a more resistence to bacterial attack of oral enviroment. Usually at the second stage of implant surgery is necessary to lift a partial thickness flap to reposition the keratinized gingiva from the top of the ridge to the buccal side of the implant, meanwhile a flapless approach results in a execution of an operculum of keratinized tissue whose margins, can be to close to the mucogengival line, not guaranteeing a minimum bandwidth of keratinized gengiva. In this study, we propose a surgical technique that, without lifting a flap, allows us to gain an amount of keratinized gingiva at the same time of implant placement, reducing surgery stages and the invasiveness of the procedure.
Aim/Hypothesis:
The aim of this study is to asseverate the validity of a surgical technique called Minimally Invasive Flap (MIF) which through a minimally invasive partial thickness flap move the crestal keratinized gingiva buccally at time of implant placement. MIF technique is applied in cases where the gingival tissues are still preserved, but the flapless approach not guarantee the preservation of an adeguate band of keratinized gingiva, and an apical repositioned flap is considered excessively intrusive.
Material and Methods:
The indication of the tecnique is in cases where the residual amplitude of keratinized gingiva is between 6 and 8 mm. We selected 20 cases to evaluate the average gain of keratinized gingiva with the approach of minimally invasive flap. We measured the amplitude of keratinized tissue prior to implant placement (T0), immediately after insertion(T1), at three months, before the protesitation (T2) ,at 6 (T3) and 12 (T4) months after insertion. We expect an increase of the band of keratinized gingiva that be stable after surgery. Trasmucosal implants with large prosthetic platform (4 to 6.5mm) or submerged implants with dedicated trasmucosal screws were used to help buccal stabilization of the flap. Surgical Technique: a partial thickness flap was made by an incision along axis of adiacent teeth, without involving papille, with a scalpel horizontal dissection in buccal side. The dissection extends still mucogengival line, mesially and distally the implant position. No releasing incision was made. The pocket flap obtained has enough mobility to be moved in buccal and apical direction by only the pressure imprinted by the trasmucosal platform of inserted implant. Usually no suture is necessary because flap results stable. Healing is made by first intention.
Results:
In all 20 patients was obtained an augmentation of band of keratinized tissue between 3 and 5 mm, The apical migration of mucogengival junction was observed in totality of cases. The neck of implants was allways sorrounded by a wide keratinized band. The healing time is less than an apical repositionig flap becouse the healing is always by first intention due to no presence of granulation tissue. The morbility is comparable at flapless implant insertion. The tecnique reduce the surgical session: no second surgery is needed. The healing period of mucosal tissues coincides with osteointegration period reducing the cumulative treatment time. The prosthetic neck of implants results more natural and esthetic, easy to clean by oral hygiene aids. The gain of keratinized gingiva appear stable during one year follow up.
Conclusions and clinical implications:
The surgical tecnique (MIF) allows to increase the amount of perimplant keratinized gingiva by a mini invasive partial-thickness flap at the same time of first surgery without additional interventions in case where is not a severe deficiency of keratinized gingiva. The tecnique need medium and long term followup to confirm clinical results obtained. The technique have to be applicated at selected cases, and always not in substitution of tissue regeneration procedures.
Background:
The presence of an adeguate width of keratinized gengiva around implants is an essential condition for long maintenance of implant health. That condition achieve more natural perimplant prostetic profiles, a more easy cleneability, a more resistence to bacterial attack of oral enviroment. Usually at the second stage of implant surgery is necessary to lift a partial thickness flap to reposition the keratinized gingiva from the top of the ridge to the buccal side of the implant, meanwhile a flapless approach results in a execution of an operculum of keratinized tissue whose margins, can be to close to the mucogengival line, not guaranteeing a minimum bandwidth of keratinized gengiva. In this study, we propose a surgical technique that, without lifting a flap, allows us to gain an amount of keratinized gingiva at the same time of implant placement, reducing surgery stages and the invasiveness of the procedure.
Aim/Hypothesis:
The aim of this study is to asseverate the validity of a surgical technique called Minimally Invasive Flap (MIF) which through a minimally invasive partial thickness flap move the crestal keratinized gingiva buccally at time of implant placement. MIF technique is applied in cases where the gingival tissues are still preserved, but the flapless approach not guarantee the preservation of an adeguate band of keratinized gingiva, and an apical repositioned flap is considered excessively intrusive.
Material and Methods:
The indication of the tecnique is in cases where the residual amplitude of keratinized gingiva is between 6 and 8 mm. We selected 20 cases to evaluate the average gain of keratinized gingiva with the approach of minimally invasive flap. We measured the amplitude of keratinized tissue prior to implant placement (T0), immediately after insertion(T1), at three months, before the protesitation (T2) ,at 6 (T3) and 12 (T4) months after insertion. We expect an increase of the band of keratinized gingiva that be stable after surgery. Trasmucosal implants with large prosthetic platform (4 to 6.5mm) or submerged implants with dedicated trasmucosal screws were used to help buccal stabilization of the flap. Surgical Technique: a partial thickness flap was made by an incision along axis of adiacent teeth, without involving papille, with a scalpel horizontal dissection in buccal side. The dissection extends still mucogengival line, mesially and distally the implant position. No releasing incision was made. The pocket flap obtained has enough mobility to be moved in buccal and apical direction by only the pressure imprinted by the trasmucosal platform of inserted implant. Usually no suture is necessary because flap results stable. Healing is made by first intention.
Results:
In all 20 patients was obtained an augmentation of band of keratinized tissue between 3 and 5 mm, The apical migration of mucogengival junction was observed in totality of cases. The neck of implants was allways sorrounded by a wide keratinized band. The healing time is less than an apical repositionig flap becouse the healing is always by first intention due to no presence of granulation tissue. The morbility is comparable at flapless implant insertion. The tecnique reduce the surgical session: no second surgery is needed. The healing period of mucosal tissues coincides with osteointegration period reducing the cumulative treatment time. The prosthetic neck of implants results more natural and esthetic, easy to clean by oral hygiene aids. The gain of keratinized gingiva appear stable during one year follow up.
Conclusions and clinical implications:
The surgical tecnique (MIF) allows to increase the amount of perimplant keratinized gingiva by a mini invasive partial-thickness flap at the same time of first surgery without additional interventions in case where is not a severe deficiency of keratinized gingiva. The tecnique need medium and long term followup to confirm clinical results obtained. The technique have to be applicated at selected cases, and always not in substitution of tissue regeneration procedures.
Background:
The presence of an adeguate width of keratinized gengiva around implants is an essential condition for long maintenance of implant health. That condition achieve more natural perimplant prostetic profiles, a more easy cleneability, a more resistence to bacterial attack of oral enviroment. Usually at the second stage of implant surgery is necessary to lift a partial thickness flap to reposition the keratinized gingiva from the top of the ridge to the buccal side of the implant, meanwhile a flapless approach results in a execution of an operculum of keratinized tissue whose margins, can be to close to the mucogengival line, not guaranteeing a minimum bandwidth of keratinized gengiva. In this study, we propose a surgical technique that, without lifting a flap, allows us to gain an amount of keratinized gingiva at the same time of implant placement, reducing surgery stages and the invasiveness of the procedure.
Aim/Hypothesis:
The aim of this study is to asseverate the validity of a surgical technique called Minimally Invasive Flap (MIF) which through a minimally invasive partial thickness flap move the crestal keratinized gingiva buccally at time of implant placement. MIF technique is applied in cases where the gingival tissues are still preserved, but the flapless approach not guarantee the preservation of an adeguate band of keratinized gingiva, and an apical repositioned flap is considered excessively intrusive.
Material and Methods:
The indication of the tecnique is in cases where the residual amplitude of keratinized gingiva is between 6 and 8 mm. We selected 20 cases to evaluate the average gain of keratinized gingiva with the approach of minimally invasive flap. We measured the amplitude of keratinized tissue prior to implant placement (T0), immediately after insertion(T1), at three months, before the protesitation (T2) ,at 6 (T3) and 12 (T4) months after insertion. We expect an increase of the band of keratinized gingiva that be stable after surgery. Trasmucosal implants with large prosthetic platform (4 to 6.5mm) or submerged implants with dedicated trasmucosal screws were used to help buccal stabilization of the flap. Surgical Technique: a partial thickness flap was made by an incision along axis of adiacent teeth, without involving papille, with a scalpel horizontal dissection in buccal side. The dissection extends still mucogengival line, mesially and distally the implant position. No releasing incision was made. The pocket flap obtained has enough mobility to be moved in buccal and apical direction by only the pressure imprinted by the trasmucosal platform of inserted implant. Usually no suture is necessary because flap results stable. Healing is made by first intention.
Results:
In all 20 patients was obtained an augmentation of band of keratinized tissue between 3 and 5 mm, The apical migration of mucogengival junction was observed in totality of cases. The neck of implants was allways sorrounded by a wide keratinized band. The healing time is less than an apical repositionig flap becouse the healing is always by first intention due to no presence of granulation tissue. The morbility is comparable at flapless implant insertion. The tecnique reduce the surgical session: no second surgery is needed. The healing period of mucosal tissues coincides with osteointegration period reducing the cumulative treatment time. The prosthetic neck of implants results more natural and esthetic, easy to clean by oral hygiene aids. The gain of keratinized gingiva appear stable during one year follow up.
Conclusions and clinical implications:
The surgical tecnique (MIF) allows to increase the amount of perimplant keratinized gingiva by a mini invasive partial-thickness flap at the same time of first surgery without additional interventions in case where is not a severe deficiency of keratinized gingiva. The tecnique need medium and long term followup to confirm clinical results obtained. The technique have to be applicated at selected cases, and always not in substitution of tissue regeneration procedures.
Background:
The presence of an adeguate width of keratinized gengiva around implants is an essential condition for long maintenance of implant health. That condition achieve more natural perimplant prostetic profiles, a more easy cleneability, a more resistence to bacterial attack of oral enviroment. Usually at the second stage of implant surgery is necessary to lift a partial thickness flap to reposition the keratinized gingiva from the top of the ridge to the buccal side of the implant, meanwhile a flapless approach results in a execution of an operculum of keratinized tissue whose margins, can be to close to the mucogengival line, not guaranteeing a minimum bandwidth of keratinized gengiva. In this study, we propose a surgical technique that, without lifting a flap, allows us to gain an amount of keratinized gingiva at the same time of implant placement, reducing surgery stages and the invasiveness of the procedure.
Aim/Hypothesis:
The aim of this study is to asseverate the validity of a surgical technique called Minimally Invasive Flap (MIF) which through a minimally invasive partial thickness flap move the crestal keratinized gingiva buccally at time of implant placement. MIF technique is applied in cases where the gingival tissues are still preserved, but the flapless approach not guarantee the preservation of an adeguate band of keratinized gingiva, and an apical repositioned flap is considered excessively intrusive.
Material and Methods:
The indication of the tecnique is in cases where the residual amplitude of keratinized gingiva is between 6 and 8 mm. We selected 20 cases to evaluate the average gain of keratinized gingiva with the approach of minimally invasive flap. We measured the amplitude of keratinized tissue prior to implant placement (T0), immediately after insertion(T1), at three months, before the protesitation (T2) ,at 6 (T3) and 12 (T4) months after insertion. We expect an increase of the band of keratinized gingiva that be stable after surgery. Trasmucosal implants with large prosthetic platform (4 to 6.5mm) or submerged implants with dedicated trasmucosal screws were used to help buccal stabilization of the flap. Surgical Technique: a partial thickness flap was made by an incision along axis of adiacent teeth, without involving papille, with a scalpel horizontal dissection in buccal side. The dissection extends still mucogengival line, mesially and distally the implant position. No releasing incision was made. The pocket flap obtained has enough mobility to be moved in buccal and apical direction by only the pressure imprinted by the trasmucosal platform of inserted implant. Usually no suture is necessary because flap results stable. Healing is made by first intention.
Results:
In all 20 patients was obtained an augmentation of band of keratinized tissue between 3 and 5 mm, The apical migration of mucogengival junction was observed in totality of cases. The neck of implants was allways sorrounded by a wide keratinized band. The healing time is less than an apical repositionig flap becouse the healing is always by first intention due to no presence of granulation tissue. The morbility is comparable at flapless implant insertion. The tecnique reduce the surgical session: no second surgery is needed. The healing period of mucosal tissues coincides with osteointegration period reducing the cumulative treatment time. The prosthetic neck of implants results more natural and esthetic, easy to clean by oral hygiene aids. The gain of keratinized gingiva appear stable during one year follow up.
Conclusions and clinical implications:
The surgical tecnique (MIF) allows to increase the amount of perimplant keratinized gingiva by a mini invasive partial-thickness flap at the same time of first surgery without additional interventions in case where is not a severe deficiency of keratinized gingiva. The tecnique need medium and long term followup to confirm clinical results obtained. The technique have to be applicated at selected cases, and always not in substitution of tissue regeneration procedures.