Intraoral Plastic Soft Tissue Surgery
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B
Figure 5.47. A. An illustration showing the incision design of the midbuccal release of flap. B. An illustration showing the flap suturing.
E
Figure 5.47E. Flap adapted and sutured properly after the midbuccal release.
C
Figure 5.47C. Three implants with the healing collars connected. The soft tissue flap could not be fully adapted to the collars. The green arrows represent the direction of the flaps to be released and sutured.
F
Figure 5.47F. Three weeks’ posthealing showing tissue response.
D
Figure 5.47D. Midbuccal releasing incisions were made.
caution when handling peri-implant soft tissues. When performing only the second-stage surgery, conservative atraumatic cosmetic incisions should be made to achieve optimal healing. It is preferable
to avoid using perpendicular incisions to the bone; more oblique or horizontal incisions are suggested. Also, 45-degree beveled incisions allow more tissue contact and adaptation between the flap and the adjacent nonflapped tissues, thus reducing the tendency for soft tissue ledge, scar tissues, or tag formation. Using scalpel microblades can provide the clinician with the maximum benefits, and using miniperiosteal elevators elevates the thin tissues with minimal trauma. (See Figure 5.50.) 8. Overcorrection: In the science of regenerative implantology, the current conceptual thinking is overdoing, or overcorrection. This means that tissues should be regenerated in excess, to overcome the behavior of the oral tissues whether bone or soft tissue volume is increased. The tissues tend to remodel; or in clinical terms, they shrink. From this perspective, during the second-stage surgery,