Effect of the use of a ready-made plastic stent on the peri-implant soft tissue.

OBJECTIVE: This study compared the effect of the use of a ready-made plastic stent on the width of peri-implant keratinized mucosa with that of conventional methods and examined the effects of a plastic stent on peri-implant soft tissue. MATERIALS AND METHODS: Five young-adult beagle dogs were used. Forty titanium implants were placed in the mandibular alveolar ridge. Stage 2 surgery was performed 8 weeks after implant installation. Each dog received a full-thickness, apically positioned flap (fAPF) with a lingual crestal incision using a suture material in the control group (n = 20) and a ready-made plastic stent in the test group (n = 20). The keratinized mucosa width after stage 2 surgery was measured in each group. The pocket depth, length of connective-tissue contact and biological width were measured in the tissue samples. A student's t-test was used to test the differences between the groups (95% confidence level). RESULTS: The width of the keratinized mucosa was significantly higher and the distance from the top of the implant platform to the mucogingival junction was significantly longer in the test group than the control group. Histometric observations revealed the pocket depth and biological width to be significantly lower in the test group than the control group. CONCLUSION: The use of a fAPF with a lingual crestal incision using a ready-made plastic stent can effectively preserve or enhance the width of the keratinized mucosa and might restore a more optimal biological environment at the early soft-tissue healing stage.

A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases.

PURPOSE: 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.