The Use of Titanium Pins for the Management and Fixation of Free Gingival Grafts and Apically Repositioned Flaps During Vestibuloplasty: A Technique Report

The presence of adequate keratinized mucosa (KM) around dental implants and natural dentition is pivotal for the long-term success of dental restorations. Despite various techniques to augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in the context of significant muscle pull or compromised tissue conditions. This study introduces a novel application of titanium pins for the fixation of free gingival grafts (FGGs) and apically repositioned flaps (APFs) during vestibuloplasty, aiming to overcome important limitations associated with traditional suturing methods, shorten the treatment time, and reduce patient morbidity. Three patients with insufficient KM width presented discomfort during oral hygiene care and showed inflammation around implant restorations and natural teeth. These patients underwent soft tissue augmentation using titanium pins—traditionally used in guided bone regeneration—to stabilize the FGGs and APFs. This method ensures intimate contact between the graft and the periosteum, which facilitates proper graft perfusion and revascularization, minimizes shrinkage, and reduces the risk of graft necrosis. A postoperative follow-up revealed successful graft integration, with minimal shrinkage and increased KM width and depth. The use of titanium pins allowed for reliable fixation in challenging surgical sites where traditional suturing methods were impractical due to the presence of extensive muscle pull and an unstable recipient bed. The application of titanium pins for the fixation of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This method simplifies and shortens the procedure, offering a predictable outcome with increased mechanical stability and minimal graft shrinkage. Randomized clinical trials are recommended to further evaluate the efficacy of this technique.