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CLINICAL STUDY OF FLAP DESIGN TO INCREASE THE KERATINIZED GINGIVA AROUND IMPLANTS. 4-YEAR FOLLOW-UP.

Abstract Purpose: 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.Materials and Methods: A total of 131 implants were placed: 103 implants (78.63%) in the mandible and 28 implants (21.37%) in the maxilla, in 85 patients. 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 in order 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-month, and every year follow-up. Measurements were reported for each implant diameter.Results: 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-year and 4-year follow-up were respectively 7.26 ± 2.01 mm and 7.37 ± 2.12 mm. The levels remained stable over time.Conclusions: This flap design allows to immediately correct the adaptation of the keratinized tissue around the implant, increasing the thickness and amount of the keratinized tissue.