Keratinized mucosa increases implant success

Increasing the width of keratinized mucosa Clinical TSIII SA around implant using apically positioned flap: comparison of two cases with different timing

By: Dae-Yeob Kim, Jong-Bin-Lee, Eun-Kyoung Pang


The width of keratinized mucosa (KM) around implant can have influence on the prognosis of osseonintegrated implants.


The aim of this study is to introduce cases of widening KM around implant using APF technique in different timing.

Case Presentation

Case 1 – Staged approach (GBR APF)

Age/Sex : 65 / F

Chief complain : discomfort on #31, 32, 41, 42

Treatment : . 5 months after extraction, implants were installed on #32, 42 site with GBR (submerged, TSIII SA Ø3.5 x 10 mm)

There was lack of KM and shallow vestibule unfavorable to oral hygiene management. 5 months after installation, second surgery was performed with APF.

Fig. 1. Panoramic radiographs, (a) Initial, (b) Post installation, (c) Final

Fig. 2. Clinical photos, (a) Post extraction, (b) Installation, (c) GBR, (d) Stitch out

Fig. 2. Clinical photos, (e) Before 2nd op, (f) Flap elevation, (g) Suture, (h) Stitch out


All implants showed uneventful healing state with good stability and KM over 2 mm were secured around implants.

Case 1 : Narrow ridge requiring augmentation Staged approach

Considering the surgery outcome, implants were submerged with GBR. Therefore, APF was performed during second surgery.

Case 2 : Slight buccal concavity without dehiscence Simultaneous approach

Through formation of double layer flap using sharp dissection of full thickness flap, APF was performed with transgingival GBR on #45i.


APF makes it possible to increased the width of KM around the implant without additional surgical intervention and donor site, even with simultaneous GBR.


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