Second stage

1. Dr R Viswa Chandra MDS;DNB
Reader
Department of Periodontics
SVS Institute of Dental Sciences
Mahabubnagar AP

2. Objectives
• To expose the submerged implant
without damaging the surrounding
bone.
• To control the thickness of the soft
tissue surrounding the implant.
• To preserve or create attached
keratinized tissue around the
implant.
• To facilitate oral hygiene.
• To ensure proper abutment
seating.

3. The cover screws of the
implant are removed and
replaced with the gingiva
former.
Primary Procedures
The gingiva is manipulated to
obtain an intact and close-
fitting junction between the
implant and the mucosa.

4. Decision Tree
Band of
keratinized tissue
Adequate
Tissue Punch
Full-thickness Flap
Sufficient Partial thickness flap-
gingivectomy technique
Deficient Tissue augmentation

5. Tissue Punch
Adequate Keratinized Gingiva

6. Adequate Keratinized Gingiva
Full Thickness Flap

7. Sufficient Keratinized Gingiva
Partial Thickness Flap-Gingivectomy Technique
Initial incision to made approximately 2mm coronal to the facial/lingual
mucogingival junction, with vertical incisions both mesially and distally.

8. Sufficient Keratinized Gingiva
Partial Thickness Flap-Gingivectomy Technique
A partial thickness flap (PT) is then raised in such a manner
that a relatively firm periosteum (P) remains. The flap, containing a
band of keratinized tissue, is then placed facial to the emerging head
of the implant fixture.
Excess tissue coronal to the cover screw is excised, usually
using a gingivectomy technique
PT
P

9. Sufficient Keratinized Gingiva
Partial Thickness Flap-Gingivectomy Technique
Suturing of the flap and post-operative view

10. Deficient Keratinized Gingiva
Connective Tissue Grafts can be
used not only to increase the
dimensions of attached tissue
around the natural dentition and
dental implants but also as a
predictable method for covering
denuded root or abutment
surfaces.