Use of Transalveolar Sutures to Maintain Vestibular Depth and Keratinized Tissue Following Alveolar Ridge Reduction and Implant Placement for Mandibular Prosthesis

Reconstruction of the totally edentulous patient with dental implants has become a routine treatment with predictable outcomes.  Firm keratinized tissue surrounding the implants and adequate vestibular depth are among the determining factors for long-term implant success. In the staged approach of mandibular implant reconstruction, adequate vestibular depth as well as attached gingiva surrounding the implants can be readily established at the time of implant placement or when the implants are uncovered. However, in cases when extractions and necessary mandibular ridge reduction to create adequate width are done immediately prior to implant placement, maintaining adequate keratinized tissue around the implants, as well as preventing prolapse of the vestibule can present a challenging situation. The aim of this report is to present a technique that allows the surgeon to stabilize vestibular depth and at the same time position the flaps around the implants and preserve the attached gingiva.