Semilunar Lingualized Apically Positioned Flap (SLAP) for Peri-implant Soft Tissue Phenotype Modification Therapy Around Mandibular Implants: A Case Report.

Abstract

Mucogingival deformities around implants are frequent findings in clinical practice and often pre- sent as inadequate keratinized tissue and insufficient mucosal thickness. Phenotype modification therapy can increase peri-implant mucosal thickness and the amount of keratinized mucosa, im- proving the long-term clinical outcomes of implants. The free gingival graft (FGG) is considered the gold standard to increase keratinized mucosa; however, FGGs on the lingual aspects of implants are less predictable due to technique sensitivity and often present with insufficient gains in tissue thick- ness due to a limited blood supply. The semilunar lingualized apically positioned flap (SLAP) with subperiosteal tunnel connective tissue graft (CTG) can increase both peri-implant mucosal thick- ness and keratinized mucosal width circumferentially. SLAP consists of one full-thickness, semi- lunar incision within the keratinized mucosa and buccal to the implant, as well as two vertical re- leasing incisions mesial and distal to the implant, extending lingually into the alveolar mucosa. The tissue is apically positioned lingual to the implant and sutured in place, creating buccal space for a CTG via buccal subperiosteal tunneling. SLAP is a minimally invasive and predictable approach for improving the peri-implant mucosal phenotype. This case report demonstrates gains in peri-implant mucosal thickness and the amount of keratinized mucosa over a 10-month period utilizing SLAP with subepithelial CTG.