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. 2024 Jul 27;16(7):e65513.
doi: 10.7759/cureus.65513. eCollection 2024 Jul.

The Effect of a Horizontal Apical Mattress Suturing Technique on the Width and Thickness of the Keratinized Mucosa After Dental Implant Surgery: A Cohort Study

Tarek Khaled Abou-Agwa  1 , Azzam Al-Jundi  2 , Yasser Khaldoun Alhalaby  1 , Hamzah Majed Alakari  1 , Mohammad Y Hajeer  3
Affiliations

The Effect of a Horizontal Apical Mattress Suturing Technique on the Width and Thickness of the Keratinized Mucosa After Dental Implant Surgery: A Cohort Study

Tarek Khaled Abou-Agwa et al. Cureus. .

Abstract

Introduction There is general agreement that a thick zone of the keratinized tissues around implants promotes accurate prosthetic procedures, permits oral hygiene maintenance, resists recession, and enables esthetic blending with surrounding tissues. A new procedure called Choukroun's technique has been suggested, and it consists of a combination of horizontal apical mattress suture with regular suture to increase the keratinized tissue in the mandibular arch during the first stage after implantation. The proposed procedure has not been evaluated yet in a cohort of patients. Therefore, this prospective study aimed to evaluate the impact of Choukroun's technique on the width and thickness of the keratinized gingiva after oral surgery. Materials and methods A one-group prospective cohort study was conducted on patients referred to the Department of Oral and Maxillofacial Surgery at the Dental College of Al-Wataniya Private University who had been referred to undergo dental implant surgery. The inclusion criteria for the study group were as follows: patients with mandibular missing teeth, good oral health, good general health, 18-70 years old, at least 1 mm thickness of keratinized gingiva, and at least 1 mm width of the attached gingiva. A total of 14 patients aged 27-67 years were included in the study. After inserting the dental implants, the suturing was accomplished according to Choukroun's method. The width and thickness of the keratinized gingiva were assessed before surgery and at one and two months post-surgery. Repeated measures analysis of variance (ANOVA) was applied to detect significant differences between assessment times. Results The study sample comprised 14 patients, of which four were females (28.6%) and 10 were males (71.4%). Patients' ages ranged from 27 to 67 years, with a mean age of 54.86 ± 11.73 years. The surgical procedure was performed in three different regions: the upper posterior teeth with four patients (28.6%), the upper anterior teeth with three patients (21.4%), and the lower posterior teeth with seven patients (50%). The mean gingival width before surgery was 5.78 mm, whereas the mean gingival thickness was 2.82 mm. There was no significant difference between the three evaluation times in the mean gingival width (P=0.222), and there was a significant difference between the three evaluation times in the mean gingival thickness (P<0.001). The mean mean gingival thickness one month after surgery was significantly greater than its mean value before surgery (mean difference: 0.749 mm). Additionally, the mean gingival thickness two months after surgery was significantly greater than its mean value before (mean differences: 0.636 mm). Conclusions Using horizontal apical mattress sutures (Choukroun's technique) does not provide any advantage in increasing the width of the keratinized gingiva. However, it does lead to an increase in the thickness of keratinized gingiva in the surgical area. Therefore, the use of horizontal apical mattress sutures is recommended.

Keywords: choukroun's technique; dental implant surgery; horizontal apical mattress suturing technique; keratinized gingiva; keratinized mucosa; soft-tissue surgery around implants; teeth missing; thickness of the keratinized gingiva; width of the keratinized gingiva.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Local Research Ethics Committee of Al-Wataniya Private University issued approval ID: 88/b/8/2022. The study protocol was approved by the Local Research Ethics Committee of Al-Wataniya Private University (ID: 88/b/8/2022). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Pre-surgical evaluation of a case from this cohort of patients.
A: A sagittal view of the CBCT image illustrating the bone condition with the virtual dental implant. B: An intraoral image before surgery. C: Measuring the width of the attached gingiva using a periodontal probe. D: Measuring the thickness of the keratinized gingiva by inserting an endodontic file with a rubber tip. E: Converting the measured distance on the endodontic file into a number using a ruler.
Figure 2
Figure 2. An intra-oral image of the lower jaw following the dental implant surgery and the performance of the suturing technique.
Figure 3
Figure 3. One-month postoperative evaluation of the case.
A: An intraoral image of the lower jaw. B: Measuring the width of the keratinized gingiva. C: Measuring the thickness of the keratinized gingiva.
Figure 4
Figure 4. Two-month postoperative evaluation of the case.
A: The width of the keratinized gingiva. B: Measuring the width of the keratinized gingiva. C: Measuring the thickness of the keratinized gingiva.
Figure 5
Figure 5. An orthodontic patient who required an implant to replace the missing lower second premolar.
A: An intraoral image of the case showing the measurement of the width of the keratinized gingiva before dental implant surgery. B: Flap elevation during surgery. C: The suturing after implant insertion. D: An intraoral image at two months postoperatively showing the measurement of the thickness of the keratinized gingiva.
See this image and copyright information in PMC

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