Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. With regards to implants, many studies suggest that the presence of healthy peri-implant soft-tissue plays an important role in long-term success of dental implants (see studies below). The video below provides a short summary of the apically repositioned flap. When you have enough attached gingiva a simple exposure or a punch will be fine. However, in many cases this is not possible, and an APF is indicated.

Block and Kent had reported that the presence of keratinized tissue was significantly associated with good mucosal health and crestal bone loss of 2 mm or greater was seen in areas with lack of KG.[1] Warrer et al., in their animal experimental study in monkeys concluded that implants without keratinized mucosa resulted in more recession and attachment loss when compared with implants with adequate keratinized tissue.[1] Chung et al., suggested that plaque accumulation and gingival inflammation were higher around dental implants with keratinized mucosa <2 mm.[2] Recent studies by Bouri et al., Kim et al., Schrott et al., reported that increased width of keratinized mucosa around dental implants is associated with lesser soft-tissue recession and greater hard tissue stability resulting in an advantage for long-term maintenance of implants.[3,4,5]

 

1. Warrer K, Buser D, Lang NP, Karring T. Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res. 1995;6:131–8. [PubMed]

2. 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;77:1410–20. [PubMed]
3. 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;23:323–6. [PubMed]
4. Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, et al. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:e24–8. [PubMed]
5. Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res. 2009;20:1170–7. [PMC free article] [PubMed]

Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Free Videos, Surgical.
Bookmark Apically Repositioned Flap Technique Around Implants

Videos to Watch:

Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!
Guided Implant Surgery & Immediate Temporisation

This video demonstrates the placement of a missing pre-molar using computer-guided surgery and immediate temporization.[...]

1 Comment

Watch Now!
Implantoplasty to Treat Peri-implantitis

This video shows the use of the Implantoplasty technique to treat peri-implantits. Granulation tissue and[...]

9 Comments

Watch Now!
Placement of Implant Using EZ Devices

This video demonstrates the placement of a dental implant in the upper jaw using the[...]

Watch Now!
BonePen: Improve Positioning of Implants

A short video demonstrating close up the use of the BonePen Kit, a set of[...]

Watch Now!
Vertical and Horizontal Bone Augmentation with Khoury Bone Plates

This video shows a way to utilize thin autogenous bone plates to create stunning bone.[...]

4 Comments

Watch Now!
Maxgraft bonering: immediate implant placement

This video shows a live surgery using the maxgraft bonering, which is a pre-fabricated[...]

1 Comment

Watch Now!