The 360-degree continuous mattress suture in dental implant surgery: A case series

The necessity of an ‘adequate’ keratinized mucosa at the emergence profile of dental implants is a controversial and debated topic. But, in recent years, research suggests that a minimum of at least 2mm of keratinized mucosa is recommended for the maintenance of peri-implant health. The latest systematic reviews on this topic are largely in favor of keratinized mucosa, as are the recommendations of some expert panels. The present paper presents a novel technique for peri-implant flap suturing that can be used in combination with soft tissue augmentation procedures, such as laterally positioned flaps, roll-flaps, and decellularized dermal matrix xenografts. The technique stabilizes the flap on the buccal surface of the healing screw or the emergence profile of the tissue-level implant with a circumferential continuous mattress design that is anchored on the buccal margins and/or periosteum with a final knot. The technique is carried out with a sterile 6/0 synthetic absorbable glyconate monofilament surgical suture (Monosyn, Bbraun, B. Braun Milano S. p.A., Via Vincenzo da Seregno, 14, 20,161 Milan, Italy). This type of suture is ideal, as it slides smoothly through the tissues and allows for the ideal adjustment of the tension and the position of the flap margins until the final knot is positioned. Furthermore, these augmentative procedures make use of second-intention healing and mattress sutures are always ideal to stabilize flap margins without excess tension in such cases. This case series involves patients with a reduced band of keratinized mucosa and, as such, in need of augmentative flap procedures.