Trans-alveolar Sliding Buccal Flap for Keratinized Mucosa Augmentation in Posterior Maxilla: A Case Report

Objective. To evaluate a trans-alveolar pedicle half-thickness flap technique for augmenting keratinized mucosa (KM) dimensions around posterior maxillary implants. Materials and Methods. Two patients with KM deficiency in the maxillary posterior region underwent modified surgery. A partial-thickness KM flap with buccal pedicle was dissected across the alveolar ridge, apically repositioned to cover implants, and secured with interrupted sutures. Precise measurements guided mucogingival junction relocation 5 mm apically. Palatal donor sites were protected using concentrated growth factor membranes. Healing abutments were connected 8 weeks post-surgery. Clinical assessments included soft tissue thickness (STT) and KM width at 3-month follow-up. Results. The technique was applied at four implant sites, achieving mean STT of 3.1 ± 0.7 mm and KM width of 4.3 ± 0.6 mm. All sites maintained stable mucosal profiles. Conclusions. This vascularized flap technique simplifies KM augmentation in maxillary molars compared to free gingival grafts, effectively enhancing peri-implant mucosal dimensions through minimally invasive approach.