Minimally Invasive Titanium Tacks-Assisted Soft Tissue Stabilization for Lingual Flap Fixation and Vestibulo-Lingual Sulcoplasty
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. Keywords: Dental implants; Vestibuloplasty; Denture; Overlay; Alveolar bone loss; Implant-supported overdentures.
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8. Kim, J.H., et al., A Comparison of Screw Fixation and Suture-Button Fixation in a Syndesmosis Injury in an Ankle Fracture. J Foot Ankle Surg, 2016. 55(5): p. 985-90.
9. Liu, J., D. Valentine, and N.A. Ebraheim, Management of Syndesmosis Injury: A Narrative Review. Orthop Res Rev, 2022. 14: p. 471-475.
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11. Fernandez-Estevan, L., et al., Oral health-related quality of life of implant-supported overdentures versus conventional complete prostheses: Retrospective study of a cohort of edentulous patients. Med Oral Patol Oral Cir Bucal, 2015. 20(4): p. e450-8.
12. Roccuzzo, M., G. Grasso, and P. Dalmasso, Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res, 2016. 27(4): p. 491-6.
13. Marin, D.O., et al., Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis. Case Rep Dent, 2017. 2017: p. 5796768.
14. Mohseni Salehi Monfared, S.H., et al., Reconstruction of lingual sulcus in a severely atrophic mandible using a modified approach as a pre-prosthetic surgery: Case series. Clin Case Rep, 2022. 10(2): p. e05500.
15. Imano, M.H., et al., A modified free gingival graft technique for gaining vertical and horizontal soft tissue augmentation. J Indian Soc Periodontol, 2019. 23(1): p. 77-80.
16. Kao, S.Y., et al., A method using vestibulo-sulcoplasty combining a split-thickness skin graft and a palatal keratinized mucosa graft for peri-implant tissue secondary to oral cancer surgery. J Oral Implantol, 2005. 31(4): p. 186-91.
17. Goyal, L., et al., Free Gingival Graft as a Single Step Procedure for Treatment of Mandibular Miller Class I and II Recession Defects. World J Plast Surg, 2019. 8(1): p. 12-17.
18. Liu, H., et al., Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs. Orthop Surg, 2023. 15(6): p. 1534-1540.
19. Getgood, A.M.J., Avoiding Graft Failure: Lessons Learned from the Stability Trial. Clin Sports Med, 2024. 43(3): p. 367-381.
20. Natarajan, S., et al., Management of Shallow Vestibule with Reduced Attached Gingiva in Fixed Prosthetic Intervention. Cureus, 2019. 11(6): p. e4975.
2. Ramasamy, M., et al., Implant surgical guides: From the past to the present. J Pharm Bioallied Sci, 2013. 5(Suppl 1): p. S98-s102.
3. Kungsadalpipob, K., et al., The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study. Int J Implant Dent, 2020. 6(1): p. 28.
4. Mehrotra, N., et al., Evaluation of hard and soft tissue changes around implant in partially edentulous patients: a clinico-radiographic study. Pan Afr Med J, 2021. 38: p. 378.
5. Zheng, C., et al., Effect of free gingival graft before implant placement on peri-implant health and soft tissue changes: a randomized controlled trial. BMC Oral Health, 2021. 21(1): p. 492.
6. Golmayo, P., et al., Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study. J Clin Periodontol, 2021. 48(2): p. 302-314.
7. Härle, F., Lowering of the floor of the mouth: open or closed? J Craniomaxillofac Surg, 1987. 15(5): p. 258-60.
8. Kim, J.H., et al., A Comparison of Screw Fixation and Suture-Button Fixation in a Syndesmosis Injury in an Ankle Fracture. J Foot Ankle Surg, 2016. 55(5): p. 985-90.
9. Liu, J., D. Valentine, and N.A. Ebraheim, Management of Syndesmosis Injury: A Narrative Review. Orthop Res Rev, 2022. 14: p. 471-475.
10. Chandra, S.S., Management of a severely resorbed mandibular ridge with the neutral zone technique. Contemp Clin Dent, 2010. 1(1): p. 36-9.
11. Fernandez-Estevan, L., et al., Oral health-related quality of life of implant-supported overdentures versus conventional complete prostheses: Retrospective study of a cohort of edentulous patients. Med Oral Patol Oral Cir Bucal, 2015. 20(4): p. e450-8.
12. Roccuzzo, M., G. Grasso, and P. Dalmasso, Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res, 2016. 27(4): p. 491-6.
13. Marin, D.O., et al., Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis. Case Rep Dent, 2017. 2017: p. 5796768.
14. Mohseni Salehi Monfared, S.H., et al., Reconstruction of lingual sulcus in a severely atrophic mandible using a modified approach as a pre-prosthetic surgery: Case series. Clin Case Rep, 2022. 10(2): p. e05500.
15. Imano, M.H., et al., A modified free gingival graft technique for gaining vertical and horizontal soft tissue augmentation. J Indian Soc Periodontol, 2019. 23(1): p. 77-80.
16. Kao, S.Y., et al., A method using vestibulo-sulcoplasty combining a split-thickness skin graft and a palatal keratinized mucosa graft for peri-implant tissue secondary to oral cancer surgery. J Oral Implantol, 2005. 31(4): p. 186-91.
17. Goyal, L., et al., Free Gingival Graft as a Single Step Procedure for Treatment of Mandibular Miller Class I and II Recession Defects. World J Plast Surg, 2019. 8(1): p. 12-17.
18. Liu, H., et al., Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs. Orthop Surg, 2023. 15(6): p. 1534-1540.
19. Getgood, A.M.J., Avoiding Graft Failure: Lessons Learned from the Stability Trial. Clin Sports Med, 2024. 43(3): p. 367-381.
20. Natarajan, S., et al., Management of Shallow Vestibule with Reduced Attached Gingiva in Fixed Prosthetic Intervention. Cureus, 2019. 11(6): p. e4975.
| Files | ||
| Issue | Vol 12, No 4 (Autumn 2025) | |
| Section | Technical Note | |
| Keywords | ||
| Dental implants; Vestibuloplasty; Denture; Overlay; Alveolar bone loss; Implant-supported overdentures. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mohseni Salehimonfared SH, Isaabadi M, Tahmasebinasab M. Minimally Invasive Titanium Tacks-Assisted Soft Tissue Stabilization for Lingual Flap Fixation and Vestibulo-Lingual Sulcoplasty. J Craniomaxillofac Res. 2026;12(4):275-281.
