The presence of an adherent keratinized gingival band around the implant is very important biological factor for the maintenance of crestal bone stability. Adequate keratinized tissue around the implant is needed to prevent soft tissue recession and to facilitate oral hygiene. In the present case, it was aimed to maintain peri-implant soft tissue health by increasing the amount of insufficiently keratinized gingiva in the anterior region of the mandible. A 62-year-old, systemically healthy male patient was found to have inadequate peri-implant keratinized tissue banding during the session in which the healing caps were to be placed. To increase the size of the adherent gingiva, apical positioned half-thickness flap was removed to determine the new position of the mucogingival line. The lifted flap was sutured to the deepest point of vestibular sulcus. Free gingival graft was taken from the palate, adapted to the recipient site and fixed to the periimplanter region with 5/0 prolene suture. Bleeding was controlled. The patient was advised accordingly. The operation site was closed with periodontal paste. No complications were observed in the early postoperative period. The patient was called to the clinic 10 days after the operation to remove the paste and sutures. At 1 month follow-up, sufficient adherent keratinized gingiva was observed around the implants. Free gingival graft applied simultaneously with the apically positioned flap technique may provide satisfactory results in cases with insufficiently adherent gingiva around the implants. The presence of adequate keratinized gingiva is an effective factor to increase the implant success rate.

Keywords: attached gingiva, free gingival graft, periimplant mucosa