Vestibuloplasty as a treatment option in cases of periimplant mucositis and periimplantitis: a report of 9 cases

Objectives: The aim of this case series of 9 cases, presenting a total of 13 implants was to evaluate the effectiveness of a modified, minimally invasive vestibuloplasty technique to reestablish stable soft tissue conditions around ailing dental implans exhibiting compromised soft tissue conditions. Methods: All treated patients exhibited moderate periimplant bone loss, increased probing depths, bleeding on probing and lack of buccal attached periimplant mucosa. Mechanical debridement and chemical disinfection of periimplant pockets were performed as conservative treatment prior to surgery. After 1 month healing time, a modified, minimally invasive vestibuloplasty procedure was used to deepen the vestibular fold, and to reestablish previously lost attached mucosa around ailing dental implants. Following local anesthesia, a paramarginal, inverse bevelled incision was placed 2-3 mm from the mucosal margin. A split thickness flap was elevated, and fixed with continous resorbable sutures (Coated Vicryl 6/0, Etichon, East Brunswick NJ, USA) to the underlying periosteal layer, 3-6 mm apically from the incision line. The uncovered periosteum was left to heal by secondary epithelialisation. Periodontal dressing was applied for 7 days; sutures were removed after 14 days. Results: 3-5 mm gain of non-inflammatory attached mucosa was observed at the buccal aspect of treated dental implants. Bleeding on probing and probing depths were reduced at each implant. Reestablished mucogingival conditions were more consecutive for oral hygiene, and helped to prevent from bacterial irritation resulting from masticatory movements. Conclusions: The presented minimally invasive, secondary epithelialisation based vestibuloplasty technique may improve soft tissue conditions around ailing dental implants. Reestablished attached mucosa, and vestibular fold may result in improved periimplant tissue health. The presented surgical approach may also serve for creating more appropriate soft tissue conditions for further periimplant hard tissue reconstructions. Parole chiave: periimplantitis, periimplant mucositis, vestibuloplasty, soft tissue reconstruction