AutoresIgnacio Pedrinaci, Javiera Casas, Samuel Akhondi, Javier Calatrava, David Palombo, Alejandro Lanis, German O. Gallucci
BACKGROUND: Peri-implant soft tissues are usually reduced when using a tissue punch in flapless static computer-assisted implant surgery (s-CAIS). The purpose of this article is to introduce a technique combining a minimally invasive guided roll flap (GRF) with s-CAIS to enhance buccal mucosal thickness and maintain peri-implant soft tissues. METHODS: A surgical template is used to define a crest-centered de-epithelialization window and to guide a palatal semilunar full-thickness pedicle that is rolled into a mid-buccal tunnel and stabilized. Osteotomy and implant placement are performed through the same template; the transmucosal profile is supported by an immediate provisional restoration, a sealing socket abutment, or a stock healing abutment. Clinical and volumetric outcomes were assessed over a 12-month follow-up. RESULTS: At 12 months, all implants demonstrated increased buccal mucosal thickness and adequate keratinized mucosa width. Volumetric analysis confirmed soft tissue volume augmentation compared to baseline. No vertical loss of adjacent papillae was observed. Clinical parameters, including PPD and BOP, remained stable, indicating maintained peri-implant health. CONCLUSIONS: This technique demonstrates the feasibility of combining s-CAIS with specific surgical approaches to potentially maintain or slightly improve peri-implant soft tissues. It offers clinicians an alternative method to the soft tissue punch, so the peri-implant soft tissues may be maintained or even augmented in a minimally invasive way.
