Rotated palatal flap. A surgical approach to increase keratinized tissue width in maxillary implant uncovering: technique and clinical evaluation

Although keratinized mucosa is not indispensible for the maintenance of periimplant tissue health if oral hygiene is adequate, its presence is generally advocated. The establishment of an adequate zone of gingiva that is firmly attached to the underlying periosteum and bone is important for the overall long-term success of implant-supported oral rehabilitation. The purpose of this study was to describe and evaluate a surgical approach for maxillary implant uncovering that augments the buccal periimplant keratinized tissue while avoiding a large zone of exposed implant-supporting bone by using a rotated palatal flap. The study comprised 40 implants that were uncovered in 13 patients using a combination of full-thickness buccally repositioned and rotated palatal flaps. Within each patient, the mean preoperative width of keratinized mucosa was 0.19 mm (SD 0.316), and the mean postoperative width was 3.45 mm (SD 0.489). The difference between post- and preoperative widths was 3.26 mm (SD 0.498), which was statistically significant according to a paired t test (P < .0001). The main advantages of this technique are simplicity and predictability, and it consistently provides a wider zone of keratinized gingiva in the buccal aspect of the future maxillary implant-supported restoration.