title: Clinical study of flap design to increase the keratinized gingiva around implants: 4-year follow-up.
abstract: 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.
authors.affiliation: 1  Private practice, Rome, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Bruschi
authors.forename: Roberto
authors.initials: R
authors.lastname: Crespi
authors.forename: Paolo
authors.initials: P
authors.lastname: Capparé
authors.forename: Enrico
authors.initials: E
authors.lastname: Gherlone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015921:Dental Implants; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D007633:Keratins; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps / Q000601:surgery*; D016019:Survival Analysis; D013536:Suture Techniques
chemical_list: D015921:Dental Implants; D007633:Keratins
keywords: partial thickness flap; peri-implant tissue; secondary intention healing