The Buccal Pedicle Sliding Flap Technique for Keratinized Tissue Augmentation During the Second-Stage Surgery: A Report of Two Cases

The need for adequacy of keratinized tissue (KT) around dental implants has been a topic of debate over the past few years. Peri-implant tissues differ from those around natural teeth. Therefore, the requirement for healthy peri-implant tissue is of importance. There is general agreement that a thick zone of KT around implants promotes accurate prosthetic procedures, permits maintenance of oral hygiene, resists recession and enables esthetic blending with surrounding tissues. Soft tissue augmentation around implants, when required, can be performed at various stages of implant therapy. The second stage of surgery involves the uncovery of the implant and placement of the healing abutment of desired collar height to achieve a biologic seal around the implant. It can be performed either by excision or by incision depending upon the clinical situation. This stage is a golden opportunity for the implant surgeon to modify the periodontal phenotype around the implant if need be. Different procedures such as palatal roll flap, rotated pedicle flap, free gingival graft, etc. can be performed to increase the keratinized tissue width (KTW) around implants. This case series demonstrates a novel minimally invasive technique to augment the KT in the maxillary arch during the second stage of surgery.