Optimisation of the lingual sulcus: The TASS technique for enhanced peri-implant stability

Oral rehabilitation of severely atrophied mandibular ridges represents one of the most complex challenges in modern implantology. Faced with an ageing population, the practitioner is increasingly confronted with insufficient vestibular depths, both buccally and lingually, compromising implant longevity.

The reconstruction of the lingual sulcus is traditionally considered more delicate due to the adjacent anatomical structures. Inadequate depth of this sulcus often limits the presence of keratinised tissue, essential for preventing peri-implant complications and ensuring patient comfort.

Study methodology

This case study presents an innovative surgical approach during second-stage implant surgery. To compensate for the lack of keratinised tissue, a flap was positioned predominantly on the lingual side. A free gingival graft (FGG) harvested from the palate was used following an "accordion" approach for the buccal aspect. For the lingual aspect, the TASS (Tack-Assisted Soft Tissue Stabilization) technique was employed: the existing keratinised tissue was fixed apically after a sharp dissection using two minimally invasive mini bone tacks.

Analysis of clinical outcomes

The 10-month clinical follow-up after vestibulo-lingual sulcoplasty demonstrates remarkable soft tissue stability. Post-operative measurements confirm the efficacy of mechanical fixation compared to conventional suturing methods.

Significant gain in vestibular depth

The procedure achieved a major improvement in gingival dimensions. Compared to the initial measurements (baseline), the depth of the lingual sulcus increased by 4 mm, while the buccal vestibule gained 6 mm in depth.

In practical terms, for the practitioner:

• Mechanical stability: The use of bone tacks (TASS) allows for a more stable and predictable apical fixation of the lingual flap than traditional sutures, which are often subject to muscle tension from the floor of the mouth.
• Surgical efficiency: This technique offers enhanced operative convenience and time savings during soft tissue management at second-stage implant surgery, while being less invasive.
• Implant longevity: By maximising the preservation and repositioning of keratinised gingiva around the implants, the TASS technique promotes a healthy peri-implant environment and facilitates oral hygiene.

Technical glossary of the study

Sulcoplasty: Surgical procedure aimed at deepening the vestibule or sulcus to increase the height of the functional alveolar ridge.

Technique TASS : Acronyme de Tack-Assisted Soft Tissue Stabilization, méthode utilisant des punaises osseuses pour fixer les tissus mous en position apicale.

Approche en accordéon : Technique de gestion des tissus mous permettant d'étendre la surface d'un greffon de gencive libre pour couvrir une zone plus large.

Tissu kératinisé : Tissu gingival dense et résistant qui entoure la dent ou l'implant, crucial pour la protection contre les agressions mécaniques et bactériennes.

Atrophie mandibulaire : Résorption osseuse de la mâchoire inférieure, réduisant la hauteur et la largeur disponibles pour la pose d'implants et la gestion des tissus mous.

Information destinée aux professionnels de santé. Ce contenu peut comporter des erreurs ou des résumés tronqués. Nous recommandons de toujours vérifier avec l'article source original. Delynov se décharge de toute responsabilité quant à l'utilisation de ces informations. Ce document n'est pas destiné aux patients ni au grand public.