Minimally Invasive Titanium Tacks-assisted Soft Tissue Stabilization for Lingual Flap Fixation and Vestibulo-Lingual Sulcoplasty

Seyed Hossein Mohseni  Salehimonafared; Mahdi  Isaabadi; Maryam  Tahmasebinasab

doi:10.18502/jcr.v12i4.21002

Seyed Hossein Mohseni Salehimonafared Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
Mahdi Isaabadi Private Practice, Periodontist, Qom, Iran.
Maryam Tahmasebinasab Department of Oral Medicine, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran.

DOI: https://doi.org/10.18502/jcr.v12i4.21002

Keywords: Dental implants; Vestibuloplasty; Denture; Overlay; Alveolar bone loss; Implant-supported overdentures.

Abstract

Introduction: In general, most countries have a rising life expectancy and an aging population. This may lead to a need for more complicated oral rehabilitation based on dental implants. The vestibular depth, either on the buccal or lingual side of the edentulous ridge, is a crucial factor in the planning of dental implant therapy. Due to the existence of lingual anatomic features, the rebuilding of the lingual sulcus may be regarded as a more difficult procedure. A severe atrophic ridge of the mandible might be considered one of the most challenging clinical situations, which may lead to inadequate lingual sulcus depth. To increase the depth of the lingual sulcus, several methods were proposed; however, the present case describes a novel surgical approach using bone tacks to address the problem.

Materials and Methods: At the second stage of implant surgery, an inadequacy of keratinized tissue was observed in the buccal and lingual regions. To solve this problem, a flap was created with the keratinized tissue positioned mostly on the lingual side. A free gingival graft taken from the palatal area was used in the accordion approach for soft tissue management on the buccal side. For lingual side management, all existing keratinized tissue was apically fixed via a sharp dissection and two minimally invasive bone Tacks.

Results: A 10-month follow-up after vestibulo-lingual sulcoplasty showed a significant improvement in lingual (4 mm) and buccal (6 mm) vestibular depth when compared to the baseline measurements.

Conclusion: The tack-assisted soft tissue stabilization (TASS) technique showed the potential to surpass conventional suturing methods in lingual flap fixation, owing to its minimally invasive approach. This technique offers stable flap fixation, surgical convenience, efficiency, and the preservation of keratinized gingiva around the implants.