Journal of Dentistry of Tehran University of Medical Sciences 2018. 15(1):41-46.

Modified Pedicle Grafting: A Novel Noninvasive Technique for Soft Tissue Augmentation Around Maxillary Dental Implants
Seyed Hossein Mohseni Salehi, Afshin Khorsand, Sahar Chokami Rafiei, Faris Yousif Mirkhan


Objectives: This study sought to assess the efficacy of modified pedicle grafting as a noninvasive technique for soft tissue augmentation around maxillary dental implants.

Materials and Methods: This descriptive study was conducted on eight patients who met the inclusion criteria. Prior to the second-stage surgery for exposing the implants, the buccal keratinized mucosa width, vestibular depth, and mucosal thickness around the implants were measured. The same parameters were measured six months after the second-stage surgery and were compared with the baseline values. Also, the color match of the graft with the adjacent gingival and mucosal tissues was evaluated.

Results: Forty-seven maxillary implants were evaluated. The minimum and maximum gains of keratinized mucosal width were respectively equal to 0mm and 7mm, with a mean of 4.31±1.19mm. The mean vestibular depth around the implants was 9.47±1.75mm (ranging from 5mm to 12mm) six months after the surgery. At the beginning of the study, a thin mucosa surrounded the implants, but after six months, the peri-implant keratinized mucosa width increased. The color match of the graft with the adjacent gingival and mucosal tissues was excellent based on the periodontists' opinion.

Conclusions: Modified pedicle grafting is a safe and predictable technique for soft tissue augmentation around maxillary implants. This technique is reliable for increasing the width of keratinized mucosa in fully and partially edentulous patients with a shallow vestibular depth. The stability of the pedicle flap is achieved by fixing the flap to the tissue around the healing abutment.


Maxillary; Dental Implants; Surgical Flaps; Soft Tissue; Augmentation; Vestibuloplasty

Full Text:



- Elkhaweldi A, Rincon Soler C, Cayarga R, Suzuki T, Kaufman Z. Various techniques to increase keratinized tissue for implant supported overdentures: retrospective case series. Int J Dent. 2015;2015:104903.

- Bhatavadekar N. Peri-implant soft tissue management: Where are we? J Indian Soc Periodontol. 2012 Oct-Dec;16(4):623-627.

- Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol. 2006 Aug;77(8):1410-20.

- Bouri A Jr, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):323-6.

- Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol. 2014 Apr;41(Suppl 15):S77-91.

- Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res. 2008 Jan;19(1):73-80.

- Kan, JY, Rungcharassaeng K, Umezu K, Kois JC. Dimensions of peri‐implant mucosa: an evaluation of maxillary anterior single implants in humans. J Periodontol. 2003 Apr;74(4):557-562.

- Halperin‐Sternfeld M, Zigdon‐Giladi H, Machtei EE. The association between shallow vestibular depth and peri‐implant parameters; a retrospective 6 years longitudinal study. J Clin Periodontol. 2015 Mar;43(3):305-10.

- Tarun Kumar AB, Divya Gayatri PS, Triveni MG, Mehta DS. Palatal pedicle flap-varied applications. Int J Oral Health Sci. 2015;5(2):106-12.

- Gilbert LR, Lohra P, Mandlik VB, Rath SK, Jha AK. Comparative evaluation of surgical modalities for coverage of gingival recession: An Armed Forces Medical College perspective. Med J Armed Forces India. 2015 Jan;71(1):53-9.

- Ladwein C, Schmelzeisen R, Nelson K, Fluegge TV, Fretwurst T. Is the presence of keratinized mucosa associated with periimplant tissue health? A clinical cross-sectional analysis. Int J Implant Dent. 2015 Dec:1(1):11.

- Suárez-López Del Amo F, Lin GH, Monje A, Galindo-Moreno P, Wang HL. Influence of Soft Tissue Thickness on Peri-Implant Marginal Bone Loss: A Systematic Review and Meta-Analysis. J Periodontol. 2016 Jun;87(6):690-9.

- Bassetti RG, Stähli A, Bassetti MA, Sculean A.Soft tissue augmentation procedures at second-stage surgery: a systematic review. Clin Oral Investig. 2016 Sep;20(7):1369-87.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.