Plastic surgery at the time of membrane removal around mandibular endosseous implants: a modified technique for implant uncovering.

Removal of barrier membranes may complicate second-stage implant surgery, particularly in mandibular areas characterized by a shallow vestibule and minimal amount of keratinized tissue. A new surgical technique that permits implant exposure and membrane removal combined with a plastic procedure to improve soft tissue quality both buccally and lingually is presented. A midcrestal incision preserving the keratinized tissue available on the lingual side is designed. A double-layer flap is elevated, allowing membrane removal. The inner, full-thickness layer is then sutured back into place, thus protecting the regenerated bone and allowing a recipient bed for a free gingival graft. The outer, partial-thickness flap is sutured apically, thus deepening the vestibule. The advantages and technical aspects of the procedure are discussed.