title: A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases.
abstract: OBJECTIVE
  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  During second stage implant surgery, an apically displaced, partial thickness flap with a lingualized incision was retracted.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.
authors.affiliation: Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.
authors.forename: Jung-Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Ki-Bin
authors.initials: KB
authors.lastname: Yang
authors.forename: Youna
authors.initials: Y
authors.lastname: Choi
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Ui-Won
authors.initials: UW
authors.lastname: Jung
authors.forename: Chang-Sung
authors.initials: CS
authors.lastname: Kim
authors.forename: Kyoo-Sung
authors.initials: KS
authors.lastname: Cho
authors.forename: Jung-Kiu
authors.initials: JK
authors.lastname: Chai
authors.forename: Chong-Kwan
authors.initials: CK
authors.lastname: Kim
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Choi
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