Customized Stent For Peri-Implant Gingiva Augmentation: A Case Report

Muscle and masticatory movements compromise peri-implant keratinized gingiva graft stability. This report describes the application of a customized stent to enhance the clinical outcome following keratinized gingiva augmentation. A 45-year-old female patient presented with a missing right mandibular molar. An implant and bone augmentation were performed at the #46 area. Intraoral examination revealed the keratinized-tissue width (KTW) of approximately 2 mm at the #46 area. Therefore, a free gingival graft was taken to increase the width of the keratinized gingiva. A customized stent was designed and fabricated based on intraoral scanning and CBCT data by thickening the soft tissue contour of the recipient site, covering the surgical area with two clasps on teeth #45 and #47. The stent was placed immediately postoperatively and worn for three months. At the first week, the patient reported no significant pain or swelling. At the three months, the atrophy rate of KTW was only 13.3%. The postoperative pain and swelling are obvious in free gingival grafting. It is reported that the atrophy rate of KTW can reach 20–40% postoperatively. In this case, the patient experienced satisfactory comfort, and the atrophy rate of KTW was only 13.3%. The application of the customized stent after peri-implant free gingival grafting demonstrates excellent clinical outcomes. This approach has the potential to become a routine postoperative management strategy for free gingival grafts in the future.