Guided roll flap in combination with static computer-assisted implant surgery: A technique report

Peri-implant soft tissues are usually reduced when using a tissue punch in flapless static computer-assisted implant surgery (s-CAIS). The purpose of this article is to introduce a technique combining a minimally invasive guided roll flap (GRF) with s-CAIS to enhance buccal mucosal thickness and maintain peri-implant soft tissues.

A surgical template is used to define a crest-centered de-epithelialization window and to guide a palatal semilunar full-thickness pedicle that is rolled into a mid-buccal tunnel and stabilized. Osteotomy and implant placement are performed through the same template; the transmucosal profile is supported by an immediate provisional restoration, a sealing socket abutment, or an stock healing abutment. Clinical and volumetric outcomes were assessed over a 12-month follow-up.

At 12 months, all implants demonstrated increased buccal mucosal thickness and adequate keratinized mucosa width. Volumetric analysis confirmed soft tissue volume augmentation compared to baseline. No vertical loss of adjacent papillae was observed. Clinical parameters, including PPD and BOP, remained stable, indicating maintained peri-implant health.

This technique demonstrates the feasibility of combining s-CAIS with specific surgical approaches to potentially maintain or slightly improve peri-implant soft tissues. It offers clinicians an alternative method to the soft tissue punch, so the peri-implant soft tissues may be maintained or even augmented in a minimally invasive way.

Static-computer assisted implant surgery integration: bridges the gap between flapless implant surgery and soft tissue management/augmentation. Enhanced peri-implant soft tissues: combines s-CAIS and modification of tissue phenotype. Minimally invasive: reduced patient morbidity due to no need for additional grafting donor sites.

Dental implants placed with flapless guided surgery can sometimes reduce the thickness of the surrounding peri-implant mucosa by the use of tissue punches. Soft tissues are essential for long-term implant health and appearance. This article presents a surgical approach that combines guided implant placement with a soft tissue management technique that repositions the site peri-implant mucosa to make it thicker instead of removing it. Using a surgical guide, the clinician knows exactly where to reshape the soft tissue and also use the same guide for implant placement. This minimally invasive approach helps to preserve or even improve the gum tissues around implants while maintaining the benefits of computer-guided surgery, potentially improving patient comfort and clinical outcomes.