Flap Designs for Minimization of Recession Adjacent to Maxillary Anterior Implant Sites: A Clinical Study

The purpose of this study is to present new flap designs for the prevention of postoperative gingival recession adjacent to maxillary anterior sites that received dental implants. Nine patients received 10 implants in the maxillary anterior region. Gingival morphotypes and smile lines were evaluated prior to implant placement. Gingival probing depths, clinical attachment levels, and recession were recorded at teeth adjacent to implant sites at the initial exam and 3 months after implant restoration. A minimum of 5 mm of crestal bone width was required for implant placement. The labial flaps for healed ridges and implants placed into sockets were extended to or within 1 to 3 mm beyond the alveolar crest. In two sites, transfer of the implant relationships was made to provide the patients with provisional restorations at the time of second-stage surgery. Four patients had implants placed at the time of tooth removal. In these patients, expanded polytetrafluoroethylene barrier membranes were modified, removing the outer rim of material. The inner portion of the material was placed over the implant and the flaps were sutured, leaving the center part of the material exposed. The purpose of using the barrier in this manner was to protect the clot and subsequent granulation tissue formation during the first 2 weeks of healing. The material was removed 2 weeks after surgery. Six implants were placed into edentulous sites. At second stage surgery, flaps were reflected to the alveolar crest, thereby minimizing the potential for gingival recession. Provisional restorations placed at the time of implant uncovering appeared to support the repositioned gingiva. Changes in probing depth, clinical attachment levels, and recession were not statistically or clinically significant. Results of this pilot project suggest that flap designs minimized recession at teeth next to implant sites. Keywords: barrier membrane, flap design, gingival morphotype, gingival recession, smile line