Simultaneously Modified Onlay Soft Tissue Graft and Apically Positioned Flap for Implant Phenotype Modification: A Case Series

Bone augmentation procedures often leads to coronal displacement of the mucogingival junction, a deficiency of keratinized mucosa, and a reduction in soft tissue height. These challenges complicate the achievement of an ideal peri-implant phenotype. It is known that addressing both the quantity and quality of soft tissue is crucial for the long-term success and aesthetics of implants. This paper introduces a novel technique for peri-implant phenotype modification following bone augmentation, which combines a modified onlay graft (MOG) with an apically positioned flap (APF) performed simultaneously with implant placement. Two clinical cases are presented to demonstrate this approach, highlighting the restoration of the soft tissue environment through a single surgical intervention. The technique resulted in successful outcomes, including increased vestibular depth, keratinized tissue width, and vertical soft tissue volume. The modified onlay graft technique effectively manages soft tissue in post-bone augmentation scenarios, providing an ideal peri-implant phenotype and leading to stable, aesthetic, and functional implant restorations. This method requires fewer surgical interventions than traditional alternatives, minimizing patient discomfort and enhancing overall treatment outcomes.