Use of transalveolar sutures to maintain vestibular depth and manipulate keratinized tissue following alveolar ridge reduction and implant placement for mandibular prosthesis.

Reconstruction of the totally edentulous patient with dental implants has become 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 and attached gingiva surrounding the implants can be readily established at the time of implant placement or when the implants are uncovered. However, when extractions and necessary mandibular ridge reduction to create adequate width are performed immediately before implant placement, maintaining adequate keratinized tissue around the implants and preventing prolapse of the vestibule can present a challenging situation. This report presents 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.