Despite the continued debate regarding the need for keratinized mucosa around dental implants, most clinicians are in agreement that keratinized peri-implant soft tissues are clinically desirable. The quantity of available keratinized mucosa in a proposed implant site can vary significantly due to local anatomy and/or previous surgical procedures. In many instances a minimal zone of keratinized tissue is noted prior to implant placement in the posterior regions, and in other instances, surgical incisions necessary for implant placement may reduce or eliminate what keratinized mucosa exists. Peri-implant concerns related to an absence of keratinized tissue, and often observed throughout the maintenance phase of treatment, can include tissue mobility, mucosal 'pouching', gingival hyperplasia, gingival fistulas, and gingivitis. Schroeder has postulated that the establishment of a circumferential sealing effect by a dense connective tissue collar at the site of implant penetration into the contaminated environment of the oral cavity was a pre-requisite for long-term implant success (Schroeder et al, 1981). Knowledge and treatment of the peri-implant tissues will continue to be an area in which the unique expertise of the periodontist is sought and valued in the partnership with restorative dentists. Surgically reconstructing keratinized tissue at the time of implant placement minimizes treatment time and reduces total expense for the patient, improves patient comfort relative to plaque control and professional maintenance, reduces marginal tissue recession, improves esthetics, and facilitates restorative procedures. This two-part article series will focus on a variety of periodontal plastic surgical techniques designed to increase the zone of keratinized mucosa around non-submerged dental implants at the time of implant placement. Specifically, this installment will elaborate on vascularized versus non-vascularized flaps.
Keywords: dental implants, peri-implant keratinized mucosa, vascularized flaps, mucoplasty, sliding pedicle flap, rotated papilla flap, internal pedicle flap