SPECIAL ARTICLE   Free access

Minerva Stomatologica 2018 October;67(5):217-24

DOI: 10.23736/S0026-4970.18.04161-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Sub-periosteal peri-implant augmented layer technique for horizontal bone augmentation at implant placement

Leonardo TROMBELLI ^{1, 2} ✉, Mattia SEVERI ¹, Mattia PRAMSTRALLER ^{1, 2}, Roberto FARINA ^{1, 2}

¹ Research Center for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy; ² Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy

In the present study, a novel surgical technique, namely the sub-periosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant will be thoroughly described. The surgical buccal access at the time of implant placement first consisted of a split-thickness flap to raise the most superficial mucosal layer, followed by the elevation of the periosteal layer which was detached from the buccal cortical bone plate (BCBP). A full-thickness flap was elevated on the oral aspect. A xenograft was used to fill the space between the periosteal layer and the BCBP, and the periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At implant uncovering at 4 months, an increase in the thickness (>2 mm) of the buccal peri-implant tissues was observed. A free gingival graft was used to enhance the dimensions of buccal keratinized mucosa. The SPAL technique may represent a surgical option for the horizontal augmentation of peri-implant tissue thickness.

KEY WORDS: Alveolar bone loss - Reconstructive surgical procedures - Surgical flaps - Dental implants - Wound healing