title: Modified connective tissue punch technique to increase the vestibular/buccal keratinized tissue on flapless implant surgery: a case series.
abstract: The aim of this article is to show a simple and predictable technique to enhance both the vestibular/buccal (V/B) gingival thickness (GT) and keratinized tissue width (KTW) improving the soft-tissue profile after flapless implant placement. The technique proposed was named Modified Connective Tissue Punch (MCTP). Fourteen patients (6 men and 8 women) aged between 35 and 69 years (mean value 48.07±13.023 years) were enrolled in this case series. Seventeen implant sites were submitted to flapless procedure. The connective punch (CP) was harvested with a motor-driven circular tissue punch and then a full-split dissection was executed, in order to create a deep pouch, beyond the mucogingival junction, on the V/B side. In this recipient site the CP was placed. The normal flapless surgical protocol was used; implants were inserted and covered with transgingival healing cap screws. GT and KTW were measured: both immediately before and after surgery; at the time of the prosthetic finalization (3-4months, respectively, for mandible and maxilla); 1 year post surgery follow-up. GT was measured at 1 mm, 2 mm and 5 mm on the V/B side, from the outline of the punch. Both KTW and GT at 1 and 2 mm can be effectively increased, while no significant effects for GT at 5 mm can be expected from this technique. Furthermore, the mean values of KTW and GT at 1 mm and 2 mm show significant increases at 3-4 months post-operative, while no further significant increments are shown at 1 year post-operative follow-up. The Authors recommend the use of the MCTP technique to reduce the number of aesthetic complications and soft tissue defects in flapless implant surgery. Longer follow-ups are needed to evaluate the stability of peri-implant tissues over time.
authors.affiliation: Private practice in Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Andreasi Bassi
authors.affiliation: Private practice in Matera, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Andrisani
authors.affiliation: Private practice in Rome, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Lopez
authors.affiliation: Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: R M
authors.initials: RM
authors.lastname: Gaudio
authors.affiliation: Department of Biomedical Sciences and Specialist Surgeries, University of Ferrara, Ferrara, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lombardo
authors.affiliation: Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lauritano
mesh_terms: D000328:Adult; D000368:Aged; D003238:Connective Tissue / Q000601:surgery*; D015921:Dental Implants; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants