Professor Markus Hürzeler, Munich/Germany, demonstrates the split flap method that is widely used in mucogingival surgery. The aim is to extend the keratinized gingiva in the peri-implant area by apically repositioning the vestibular mucosa.

Following an incision along the alveolar ridge and relaxing incisions at the endings, a mucosal flap is created, which is mobilized towards the vestibule. The six implants that had been inserted six months ago are uncovered using a corresponding punch to remove the covering connective tissue. One nonintegrated implant and the augmentation membrane that had been placed for augmentation purposes during the implantation have to be removed. In the posterior area a graft bed is prepared for the reception of a free gingival graft. It is important to carefully remove underlying connective tissue from the periosteum. The thinned mucosal flap is then secured and immobilized in an apical position using absorbable suture material. A corresponding free gingival graft is harvested from the palate and placed in its recipient bed. An even thickness of the graft of about 1-1.5 mm is desired for an undisturbed healing process.

Finally, the mucosal flap is firmly secured slightly apically with a Gore-Tex material. Uncovered areas will heal with the development of granulation tissue. In the meantime, the existing prosthesis has been reworked and adjusted to the new situation with the five uncovered implants and is inserted at the end of the surgery.