Fibrin immobilization vestibular extension (FIVE): A case series

Abstract

Aims The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri‐implant mucosal phenotype modification therapy, referred to as “fibrin immobilization vestibular extension (FIVE)”. Material and Methods The protocol utilized entailed apical positioning and stabilization of peri‐implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet‐rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap. Results A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri‐implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5–5.2 mm) of peri‐implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5–4.5 mm) at 3 years post‐FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8–6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6–5.6 mm). The mean of maxilla was significantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri‐implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri‐implantitis patients were removed due to advanced peri‐implantitis. Discussion The present case series provides proof‐of‐principle data for efficacy of FIVE for peri‐implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft.