Ａ Novel Technique of Tacking Free Gingival Flaps to Soft Tissue Augmentation Surgery(Pin technique)

Ａ Novel Technique of Tacking Free Gingival Flaps to Soft Tissue Augmentation Surgery(Pin technique) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ａ Novel Technique of Tacking Free Gingival Flaps to Soft Tissue Augmentation Surgery(Pin technique) Ying Wang, Penghuan Luo, Yan Wang, Yingxin Chen, Man Fu, Youhao Chen, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9151534/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract A dequate keratinized mucosa thickness is essential for the long-term health and esthetics of the peri-implant area. All along, for patients with soft tissue defects, FGG is the most commonly used treatment method. Although it can achieve better therapeutic effects, it also causes significant secondary injury areas. Objective : To achieve minimally invasive soft tissue augmentation without sutures, using tent pins to fix the soft tissue and ensure more reliable tissue stabilization. Materials and methods : This article describes a novel soft tissue augmentation technique that replaces conventional FGG with a combination of bone trephine and tack fixation. Results : All patients with this technique showed an improvement in their keratinized mucosal thickness in 1 month. No complications were observed, and all cases achieved tension-free healing and aesthetic outcomes. Conclusion : Pin technique has emerged as a reliable and predictable minimally invasive treatment approach for addressing insufficient peri-implant keratinized gingiva. soft tissue augmentation minimally invasive sutureless mouth mucosa oral surgical procedures Figures Figure 1 Figure 2 Figure 3 Introduction Due to the different tissue structures of keratinized and non-keratinized gingiva, their functions also differ. The former can resist chewing friction and external stimuli, which is crucial for maintaining gingival stability and protecting periodontal tissues 1, 2 . The latter is a thin and fragile adherent tissue, unsuitable for chewing function. Keratinized epithelial mucosa is defined as the part that extends from the top of the mucosal margin surrounding the implant to the movable inner mucosa 3 .For patients undergoing dental implants following tooth loss, alveolar bone resorption is a common cause of insufficient keratinized gingiva before implant placement 4 . Alveolar bone resorption can reduce the height of the alveolar ridge, thereby shortening the distance between the mucogingival junction and the crest of the alveolar ridge. This anatomical change ultimately leads to the loss of keratinized gingiva, which can significantly affect the success rate of dental implants and the aesthetic outcome after restoration 5 . Studies have shown that adequate keratinized mucosa width(KMW>2mm) and soft tissue thickness can reduce plaque accumulation around implants, lower the incidence of peri-implantitis, and decrease peri-implant bone resorption 6 . To reduce the risk of implant failure caused by insufficient keratinized gingiva, methods for widening and thickening the keratinized gingiva include Free gingival grafts (FGG), apically repositioned flap (ARF) , Soft tissue substitute materials (STM) and connective tissue graft (CTG) 7 .FGG is widely used to repair insufficient KMW at implant sites, making it the gold standard for keratinized mucosa widening procedures 8 . FGG and CTG have good long-term effects 7, 9 , but they can cause significant secondary injury to the area, manifested as severe postoperative complications, pain, and bleeding 10, 11 . Furthermore, FGGs have been reported to result in less gum recession but poor color matching to the surrounding tissue 12-14 . In addition, the duration of the surgery has a significant impact on the occurrence of postoperative complications. For each additional minute of gingival grafting surgery, pain may increase by 4% and swelling by 3% 15 . Compared to subepithelial connective tissue graft (SCTG), FGG carries a higher risk of postoperative pain or bleeding, while the use of STM significantly reduces the likelihood of swelling and bleeding 16, 17 . This led to the development of artificial substitute repair materials. Observations indicate that artificial repair materials exhibit greater graft shrinkage than FGG post-surgery 18, 19 . ARF has been applied in soft tissue augmentation around implants early.The flap is opened through horizontal internal bilateral vertical incision and oblique incision, pushed apically and then sutured and fixed, so the exposed periosteal area can self- heal and form keratinized gingiva. ARF can effectively restore the width of keratinized gingiva but The effect is unstable 20 . Combined with CTG or FGG, it can restore the thickness of keratinized gingiva, which provides excellent stability 21, 22 . However, all of the above approaches require high level of suturing techniques to achieve complete wound closure. Therefore, we propose an improved soft tissue grafting technique aimed at minimizing trauma to the secondary surgical area and reducing the need for suturing. For cases with minimal soft tissue defects, this technique can serve as an alternative to FGG, in order to restore the color and aesthetic form of the gingival tissue around the implant.The following table is a contrast of various soft tissue augmentation surgeries(Table 1). Table1.Overall Comparison of Soft Tissue Augmentation in Oral Implant Surgery Suitable Condition Advantages Disadvantages FGG Severe deficiency of keratinized gingiva, gingival recession Suitable for severe keratinized gingival defects High suturing requirements; Inconsistent color recovery; Larger damage CTG Severe deficiency of keratinized gingiva, gingival recession Suitable for severe keratinized gingival defects; Bidirectional blood supply High suturing requirements ARF Narrow attachment gingival height No secondary injury area High suturing requirements STM Severe deficiency of keratinized gingiva, gingival recession No secondary injury area High suturing requirements;high-cost SFGG(SimplifiedFGG) Severe deficiency of keratinized gingiva, gingival recession Reliable fixation; Not affected by muscle movement; low-cost; Low suturing requirements Inconsistent color recovery Pin technique Slight deficiency of keratinized gingiva Faster; Smaller damage; Reliable fixation; Not affected by muscle movement; low-cost; Low suturing requirements; Consistent color recovery Limited applicability Techniques Patients with buccal or labial keratotic gingival defects, after measuring the extent of the defect with a periodontal probe, are classified as having milder keratotic gingival defects, which can be termed K-shaped defects, thus meeting the indications for the Pin technique(Fig. 1A-B). Using a 10mm inner diameter trephine (Meisinger trephine kit,Germany)(Fig. 1C-D), a circular gingival tissue flap was harvested from the patient's maxilla(Fig. 1E),because of its round shape and the fact that it is fixed with tent pegs, it is named Pin,and will be referred to as Pin in the following text. And the fatty tissue inside the flap was scraped away(Fig. 1F-H). The recipient area (i.e., K-shaped defect area) was treated with an umbrella-shaped diamond abrasive head for dekeratinization. A small amount of bleeding was observed in the recipient area, indicating good blood supply. (Fig. 1I-J). Prepare tent pins and a tent pin kit (Osstem, Korea)(Fig. 1K-L). Use the tent pins to fix the Pin to the K-shaped defect recipient area. Use a periodontal probe to measure the size of the fixed Pin for subsequent data comparison(Fig. 1M-O) . This soft tissue augmentation case underwent clinical follow-up at 1 week and 1 month post-surgery. The soft tissue healed well at 1 week post-surgery(Fig.2A-E). From 1 week to 1 month post-surgery, the Pin gradually climbed and grew coronally, thereby compensating for the K-type defect and achieving the goal of widening and thickening the keratotic gingiva(Fig.2F-J).To more concisely illustrate the simplicity and practicality of the Pin technique, we can more clearly understand the key processes of the Pin technique in the diagram(Fig.3A-D). This technique has broad applicability in the treatment of K-type keratotic gingival defects. In the donation area, gelatin sponge was used for compression and suture to stop bleeding(Fig.1P). Discussion With the continuous advancement of oral implantology, the demand for treatments addressing gingival recession and soft tissue defects has grown. Consequently, the concept and technique of FGG gradually took shape in the mid-20th century.For cases of soft tissue insufficiency, the most common approach is the FGG,which can improve peri-implant periodontal health and aesthetic outcomes. However, this technique requires meticulous suturing to ensure proper wound closure. Tent Pins are widely used in implant surgery. For example, in GBR surgeries, tent pins can support the barrier membrane, maintain and stabilize the space for bone formation, and reduce collapse and resorption of the bone graft material 23-26 ;in bone augmentation surgery, fix the collagen membrane 26 and autologous bone blocks 27 .The Pin technique described in this article utilizes tent pins to fix free flaps, achieving sutureless fixation and greatly shortening the surgical time. This innovative technique simplifies the surgical procedure and reduces the sensitivity required for the operation. Observations indicate that patients who received the Pin technique showed good restoration of the color and morphology of the soft tissue at the surgical site at 1 week, 2 weeks, and 1 month postoperatively. Compared with FGG and SFGG, the Pin technique can achieve better healing outcomes. The ratio of the tent peg head diameter to the free gingival graft diameter is about 1:2, which rarely causes rolling in or out of the wound edges. Literature reports the use of tent pegs to fix FGG for soft tissue augmentation (SFGG) 28 , and this method has a wide range of applications. Compared with the Pin technique, its surgical operation time is longer, and the healing color and morphology are generally average, still relying on sutures for fixation. The Pin technique, on the other hand, not only truly achieves suture-free fixation in the recipient area but, due to its intraosseous fixation, tissue healing is not affected by the pull of the labial or buccal frenum, and there is no risk of suture loosening. Pin technique uses circular incision techniques to obtain a round, partial-thickness free gingival flap, eliminating the need for pre-measuring the donor site flap size and reducing bleeding and pain. Since the trauma to the upper jaw is minor, no gauze compression is needed, and hemostasis can be achieved using suturing to complete the treatment of the palate 29 .For patients with insufficient keratinized gingiva in the anterior teeth region, we can consider harvesting a free gingival flap from the buccal side of the posterior teeth to achieve an increase in the labial soft tissue of the anterior teeth region 30 . This study found that a small amount of wound exposure in the surgical area can still achieve complete healing. The newly formed epithelium can migrate and grow over the wound area, covering the exposed site, meaning that after transplantation, perfect wound closure is not necessary to achieve good healing results. This technique can be used in conjunction with other methods to achieve different effects. For example, adding a root-positioned flap can increase the thickness of the keratinized gingiva while also deepening the vestibular groove. The limitations of this technology mainly lie in the restricted indications. In cases of extensive soft tissue defects or multiple consecutive tooth losses, it is difficult to restore the width of keratinized gingiva and the fullness of the buccal gingiva. Additionally, the placement of tent screws needs to avoid the implants and adjacent tooth roots, which requires the physician to have considerable experience. Patients may experience a significant foreign body sensation in the initial postoperative period, requiring an adaptation phase. Conclusions In summary, the Pin technique described in this article achieves seamless, minimally invasive soft tissue thickening, eliminates the risk of suture loosening, reduces procedural difficulty, is easy for doctors to perform, and provides a more comfortable surgical experience for patients. Compared to FGG and CTG, it avoids excessive removal of soft tissue, thereby reducing postoperative pain, bleeding, and other reactions. Unlike the root-oriented repositioned flap, this technique not only widens the attached gingiva but also thickens the gingival tissue. In other words, Pin can maximize the benefits for patients with lip and buccal soft tissue defects within a relatively short surgical time.Conducting further investigations with larger sample sizes and rigorous methods is crucial for validating and extending our finding. Abbreviations KMW: Keratinized mucosa width FGG: Free gingival graft ARF: Apically repositioned flap STM: Soft tissue substitute materials CTG: Connective tissue graft SCTG: Subepithelial connective tissue graft SFGG: Simplified free gingival graft GBR: Guided bone regeneration Declarations Ethics approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the West China Hospital of Stomatology Institute Review Board (WCHSIRB)(approval number:WCHSIRB-CT-2024-438).All participants provided informed consent to participate in the study. Consent for publication Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This report received no funding. Author’s contributions Y. Wang and P. Luo Image collection and case providers, article writing. Yan Wang, Yingxin Chen, Man Fu, Youhao Chen, Yanlin Ren, case providers. Quan Yuan, Bo Shao critical review of the manuscript. Boxi Fan and Yang Yao: method maker and critical review of the manuscript. Acknowledgements Not applicable. References Shahramian K, Gasik M, Kangasniemi I, et al. Zirconia implants with improved attachment to the gingival tissue. Journal of periodontology. 2020;91(9):1213-1224. Monje A, Blasi G. Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers. Journal of periodontology. 2019;90(5):445-453. Araujo MG, Lindhe J. Peri-implant health. Journal of clinical periodontology. 2018;45 Suppl 20:S230-s236. Bodic F, Hamel L, Lerouxel E, et al. Bone loss and teeth. Joint bone spine. 2005;72(3):215-221. Monje A, González-Martín O, Ávila-Ortiz G. Impact of peri-implant soft tissue characteristics on health and esthetics. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry [et al]. 2023;35(1):183-196. Agarwal S, Sachdev SS, Mistry LN, et al. Soft Tissue Management in Implant Dentistry: A Comprehensive Review. Cureus. 2025;17(2):e79557. Tavelli L, Barootchi S, Akhondi S, et al. Long-term stability of soft tissue augmentative procedures at implant sites. Periodontology 2000. 2025. Zhang S, Sheng R, Fan Z, et al. Expert consensus on peri-implant keratinized mucosa augmentation at second-stage surgery. International journal of oral science. 2025;17(1):51. Stefanini M, Barootchi S, Sangiorgi M, et al. Do soft tissue augmentation techniques provide stable and favorable peri-implant conditions in the medium and long term? A systematic review. Clinical oral implants research. 2023;34 Suppl 26:28-42. Puzio M, Hadzik J, Błaszczyszyn A, et al. Soft tissue augmentation around dental implants with connective tissue graft (CTG) and xenogenic collagen matrix (XCM). 1-year randomized control trail. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft. 2020;230:151484. Escobar M, Brum RS, Apaza-Bedoya K, et al. Dimensional Influence of Epithelialized Tissue Graft Harvested From Palate on Postoperative Pain: a Systematic Review. Journal of oral & maxillofacial research. 2022;13(3):e1. Lim HC, An SC, Lee DW. A retrospective comparison of three modalities for vestibuloplasty in the posterior mandible: apically positioned flap only vs. FGG vs. collagen matrix. Clinical oral investigations. 2018;22(5):2121-2128. de Resende DRB, Greghi SLA, Siqueira AF, et al. Acellular dermal matrix allograft versus FGG: a histological evaluation and split-mouth randomized clinical trial. Clinical oral investigations. 2019;23(2):539-550. Yilmaz BT, Comerdov E, Kutuk C, et al. Modified coronally advanced tunnel versus epithelialized FGG technique in gingival phenotype modification: a comparative randomized controlled clinical trial. Clinical oral investigations. 2022;26(10):6283-6293. Griffin TJ, Cheung WS, Zavras AI, et al. Postoperative complications following gingival augmentation procedures. Journal of periodontology. 2006;77(12):2070-2079. Cairo F, Pagliaro U, Buti J, et al. Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. Journal of clinical periodontology. 2016;43(11):965-975. Cairo F, Barbato L, Tonelli P, et al. Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial. Journal of clinical periodontology. 2017;44(7):769-776. Ramanauskaite A, Müller KM, Schliephake C, et al. Volumetric changes of porcine collagen matrix and FGGs for soft-tissue grafting to increase the width of keratinized tissue around dental implants: a retrospective clinical study. International journal of implant dentistry. 2024;10(1):52. Ramanauskaite A, Obreja K, Müller KM, et al. Three-dimensional changes of a porcine collagen matrix and FGGs for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study. International journal of implant dentistry. 2023;9(1):13. Basegmez C, Ersanli S, Demirel K, et al. The comparison of two techniques to increase the amount of peri-implant attached mucosa: FGGs versus vestibuloplasty. One-year results from a randomised controlled trial. European journal of oral implantology. 2012;5(2):139-145. Tunkel J, de Stavola L, Khoury F. Changes in soft tissue dimensions following three different techniques of stage-two surgery: a case series report. The International journal of periodontics & restorative dentistry. 2013;33(4):411-418. Han CY, Wang DZ, Bai JF, et al. Peri-implant keratinized gingiva augmentation using xenogeneic collagen matrix and platelet-rich fibrin: A case report. World journal of clinical cases. 2021;9(34):10738-10745. Keddar M, Evrard L, Shall F. Horizontal ridge augmentation using guided bone regeneration with an association of particulate allografts mixed with platelet-rich fibrin, collagen membrane and tent-screws: A prospective study. Journal of stomatology, oral and maxillofacial surgery. 2024;125(12 Suppl 2):101872. Wang S, Chen X, Wu W, et al. Tenting Screw Technique for Horizontal Alveolar Bone Augmentation in the Anterior Maxilla: A 1- to 5-Year Retrospective Study. Clinical oral implants research. 2025;36(7):821-834. Reddy TS, Shah NR, Roca AL, et al. Space Maintenance Using Tenting Screws in Atrophic Extraction Sockets. The Journal of oral implantology. 2016;42(4):353-357. Hempton TJ, Fugazzotto PA. Ridge augmentation utilizing guided tissue regeneration, titanium screws, freeze-dried bone, and tricalcium phosphate: clinical report. Implant dentistry. 1994;3(1):35-37. Berberi A, Nader N, Noujeim Z, et al. Horizontal and vertical reconstruction of the severely resorbed maxillary jaw using subantral augmentation and a novel tenting technique with bone from the lateral buccal wall. Journal of maxillofacial and oral surgery. 2015;14(2):263-270. Lee WP, You JS, Oh JS. Technical Note on Simplified FGG Using Tack Fixation (sFGG). Medicina (Kaunas, Lithuania). 2023;59(12). Jankowski T, Jankowska A, Palczewska-Komsa M, et al. Patient Experience and Wound Healing Outcomes Using Different Palatal Protection Methods After FGGs: A Systematic Review. Journal of functional biomaterials. 2024;15(12). Moslemi N, Rahami M, Shokri M, et al. Utilization of Buccal FGG to Restore the Peri-Implant Soft Tissue Texture and Color Match in the Esthetic Zone: A Case Report With 3 Years Follow-Up. Clinical case reports. 2025;13(8):e70781. Additional Declarations No competing interests reported. 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Use an umbrella-shaped diamond abrasive head to exfoliate the treated area(I-J).Tent pin kit (Osstem, Korea)(K).Tent pin(L).Secure tent pegs and Pin(M-O).Donor site suturing(P).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9151534/v1/fe0d070ad33ae2d9f5c5947e.jpg"},{"id":106404312,"identity":"86914fec-a8b6-49c0-b927-89310ca3a633","added_by":"auto","created_at":"2026-04-08 09:15:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58460,"visible":true,"origin":"","legend":"\u003cp\u003eFollow-up 1 week after surgery(A-E).Follow-up 1 month after surgery(F-J).\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9151534/v1/f9849887295dc3f5e96060af.jpg"},{"id":106382786,"identity":"30b64af1-70ae-4ebd-b15d-c91f7813da8c","added_by":"auto","created_at":"2026-04-08 05:30:52","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":26599,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of Pin technique(A-D).\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9151534/v1/7cbe905f7b0970805235cd88.jpg"},{"id":106405641,"identity":"22755a50-44e7-4b80-9942-67c307af8539","added_by":"auto","created_at":"2026-04-08 09:28:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":636755,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9151534/v1/f1c65bb7-5fd9-4a3a-a4c5-2c2ff3e4a7c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ａ Novel Technique of Tacking Free Gingival Flaps to Soft Tissue Augmentation Surgery(Pin technique)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDue to the different tissue structures of keratinized and non-keratinized gingiva, their functions also differ. The former can resist chewing friction and external stimuli, which is crucial for maintaining gingival stability and protecting periodontal tissues\u003csup\u003e1, 2\u003c/sup\u003e. The latter is a thin and fragile adherent tissue, unsuitable for chewing function. Keratinized epithelial mucosa is defined as the part that extends from the top of the mucosal margin surrounding the implant to the movable inner mucosa\u003csup\u003e3\u003c/sup\u003e.For patients undergoing dental implants following tooth loss, alveolar bone resorption is a common cause of insufficient keratinized gingiva before implant placement\u003csup\u003e4\u003c/sup\u003e. Alveolar bone resorption can reduce the height of the alveolar ridge, thereby shortening the distance between the mucogingival junction and the crest of the alveolar ridge. This anatomical change ultimately leads to the loss of keratinized gingiva, which can significantly affect the success rate of dental implants and the aesthetic outcome after restoration\u003csup\u003e5\u003c/sup\u003e. Studies have shown that adequate keratinized mucosa width(KMW\u0026gt;2mm) and soft tissue thickness can reduce plaque accumulation around implants, lower the incidence of peri-implantitis, and decrease peri-implant bone resorption\u003csup\u003e6\u003c/sup\u003e. To reduce the risk of implant failure caused by insufficient keratinized gingiva, methods for widening and thickening the keratinized gingiva include Free gingival grafts (FGG), apically repositioned flap (ARF) , Soft tissue substitute materials (STM) and connective tissue graft (CTG)\u003csup\u003e7\u003c/sup\u003e .FGG is widely used to repair insufficient KMW at implant sites, making it the gold standard for keratinized mucosa widening procedures\u003csup\u003e8\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eFGG and CTG have good long-term effects\u003csup\u003e7, 9\u003c/sup\u003e, but they can cause significant secondary injury to the area, manifested as severe postoperative complications, pain, and bleeding\u003csup\u003e10, 11\u003c/sup\u003e. Furthermore, FGGs have been reported to result in less gum recession but poor color matching to the surrounding tissue\u003csup\u003e12-14\u003c/sup\u003e. In addition, the duration of the surgery has a significant impact on the occurrence of postoperative complications. For each additional minute of gingival grafting surgery, pain may increase by 4% and swelling by 3%\u003csup\u003e15\u003c/sup\u003e. Compared to subepithelial connective tissue graft (SCTG), FGG carries a higher risk of postoperative pain or bleeding, while the use of STM significantly reduces the likelihood of swelling and bleeding\u003csup\u003e16, 17\u003c/sup\u003e. This led to the development of artificial substitute repair materials. Observations indicate that artificial repair materials exhibit greater graft shrinkage than FGG post-surgery\u003csup\u003e18, 19\u003c/sup\u003e. \u0026nbsp;ARF has been applied in soft tissue augmentation around implants early.The flap is opened through horizontal internal bilateral vertical incision and oblique incision, pushed apically and then sutured and fixed, so the exposed periosteal area can self- heal and form keratinized gingiva. ARF can effectively restore the width of keratinized gingiva but The effect is unstable\u003csup\u003e20\u003c/sup\u003e. Combined with CTG or FGG, it can restore the thickness of keratinized gingiva, which provides excellent stability\u003csup\u003e21, 22\u003c/sup\u003e.\u003c/p\u003e\n\u003cpre\u003eHowever, all of the above approaches require high level of suturing techniques to achieve complete wound closure. Therefore, we propose an improved soft tissue grafting technique aimed at minimizing trauma to the secondary surgical area and reducing the need for suturing. For cases with minimal soft tissue defects, this technique can serve as an alternative to FGG, in order to restore the color and aesthetic form of the gingival tissue around the implant.The following table is a contrast of various soft tissue augmentation surgeries(Table 1).\u003c/pre\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"688\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 688px;\"\u003e\n \u003cp\u003eTable1.Overall Comparison of Soft Tissue Augmentation in Oral Implant Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSuitable Condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAdvantages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eDisadvantages\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eFGG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSevere deficiency of keratinized gingiva, gingival recession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSuitable for severe keratinized gingival defects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eHigh suturing requirements; Inconsistent color recovery; Larger damage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eCTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSevere deficiency of keratinized gingiva, gingival recession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSuitable for severe keratinized gingival defects;\u003c/p\u003e\n \u003cp\u003eBidirectional blood supply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eHigh suturing requirements\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eARF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eNarrow attachment gingival height\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNo secondary injury area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eHigh suturing requirements\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eSTM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSevere deficiency of keratinized gingiva, gingival recession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNo secondary injury area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eHigh suturing requirements;high-cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eSFGG(SimplifiedFGG)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSevere deficiency of keratinized gingiva, gingival recession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eReliable fixation; Not affected by muscle movement; low-cost; Low suturing requirements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eInconsistent color recovery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003ePin technique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSlight deficiency of keratinized gingiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFaster; Smaller damage; Reliable fixation; Not affected by muscle movement; low-cost; Low suturing requirements; Consistent color recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eLimited applicability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Techniques","content":"\u003col\u003e\n \u003cli\u003ePatients with buccal or labial keratotic gingival defects, after measuring the extent of the defect with a periodontal probe, are classified as having milder keratotic gingival defects, which can be termed K-shaped defects, thus meeting the indications for the Pin technique(Fig. 1A-B).\u003c/li\u003e\n \u003cli\u003eUsing a 10mm inner diameter trephine (Meisinger trephine kit,Germany)(Fig. 1C-D), a circular gingival tissue flap was harvested from the patient\u0026apos;s maxilla(Fig. 1E),because of its round shape and the fact that it is fixed with tent pegs, it is named Pin,and will be referred to as Pin in the following text. And the fatty tissue inside the flap was scraped away(Fig. 1F-H).\u003c/li\u003e\n \u003cli\u003eThe recipient area (i.e., K-shaped defect area) was treated with an umbrella-shaped diamond abrasive head for dekeratinization. A small amount of bleeding was observed in the recipient area, indicating good blood supply. (Fig. 1I-J).\u003c/li\u003e\n \u003cli\u003ePrepare tent pins and a tent pin kit (Osstem, Korea)(Fig. 1K-L). Use the tent pins to fix the Pin to the K-shaped defect recipient area. Use a periodontal probe to measure the size of the fixed Pin for subsequent data comparison(Fig. 1M-O) .\u003c/li\u003e\n \u003cli\u003eThis soft tissue augmentation case underwent clinical follow-up at 1 week and 1 month post-surgery. The soft tissue healed well at 1 week post-surgery(Fig.2A-E). From 1 week to 1 month post-surgery, the Pin gradually climbed and grew coronally, thereby compensating for the K-type defect and achieving the goal of widening and thickening the keratotic gingiva(Fig.2F-J).To more concisely illustrate the simplicity and practicality of the Pin technique, we can more clearly understand the key processes of the Pin technique in the diagram(Fig.3A-D). This technique has broad applicability in the treatment of K-type keratotic gingival defects.\u003c/li\u003e\n \u003cli\u003eIn the donation area, gelatin sponge was used for compression and suture to stop bleeding(Fig.1P).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith the continuous advancement of oral implantology, the demand for treatments addressing gingival recession and soft tissue defects has grown. Consequently, the concept and technique of FGG gradually took shape in the mid-20th century.For cases of soft tissue insufficiency, the most common approach is the FGG,which can improve peri-implant periodontal health and aesthetic outcomes. However, this technique requires meticulous suturing to ensure proper wound closure.\u003c/p\u003e\n\u003cp\u003eTent Pins are widely used in implant surgery. For example, in GBR surgeries, tent pins can support the barrier membrane, maintain and stabilize the space for bone formation, and reduce collapse and resorption of the bone graft material\u003csup\u003e23-26\u003c/sup\u003e;in bone augmentation surgery, fix the collagen membrane \u003csup\u003e26\u003c/sup\u003eand autologous bone blocks\u003csup\u003e27\u003c/sup\u003e.The Pin technique described in this article utilizes tent pins to fix free flaps, achieving sutureless fixation and greatly shortening the surgical time. This innovative technique simplifies the surgical procedure and reduces the sensitivity required for the operation. Observations indicate that patients who received the Pin technique showed good restoration of the color and morphology of the soft tissue at the surgical site at 1 week, 2 weeks, and 1 month postoperatively.\u003c/p\u003e\n\u003cp\u003eCompared with FGG and SFGG, the Pin technique can achieve better healing outcomes. The ratio of the tent peg head diameter to the free gingival graft diameter is about 1:2, which rarely causes rolling in or out of the wound edges. Literature reports the use of tent pegs to fix FGG for soft tissue augmentation (SFGG)\u003csup\u003e28\u003c/sup\u003e, and this method has a wide range of applications. Compared with the Pin technique, its surgical operation time is longer, and the healing color and morphology are generally average, still relying on sutures for fixation. The Pin technique, on the other hand, not only truly achieves suture-free fixation in the recipient area but, due to its intraosseous fixation, tissue healing is not affected by the pull of the labial or buccal frenum, and there is no risk of suture loosening.\u003c/p\u003e\n\u003cp\u003ePin technique uses circular incision techniques to obtain a round, partial-thickness free gingival flap, eliminating the need for pre-measuring the donor site flap size and reducing bleeding and pain. Since the trauma to the upper jaw is minor, no gauze compression is needed, and hemostasis can be achieved using suturing to complete the treatment of the palate\u003csup\u003e29\u003c/sup\u003e.For patients with insufficient keratinized gingiva in the anterior teeth region, we can consider harvesting a free gingival flap from the buccal side of the posterior teeth to achieve an increase in the labial soft tissue of the anterior teeth region\u003csup\u003e30\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study found that a small amount of wound exposure in the surgical area can still achieve complete healing. The newly formed epithelium can migrate and grow over the wound area, covering the exposed site, meaning that after transplantation, perfect wound closure is not necessary to achieve good healing results. This technique can be used in conjunction with other methods to achieve different effects. For example, adding a root-positioned flap can increase the thickness of the keratinized gingiva while also deepening the vestibular groove.\u003c/p\u003e\n\u003cp\u003eThe limitations of this technology mainly lie in the restricted indications. In cases of extensive soft tissue defects or multiple consecutive tooth losses, it is difficult to restore the width of keratinized gingiva and the fullness of the buccal gingiva. Additionally, the placement of tent screws needs to avoid the implants and adjacent tooth roots, which requires the physician to have considerable experience. Patients may experience a significant foreign body sensation in the initial postoperative period, requiring an adaptation phase.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, the Pin technique described in this article achieves seamless, minimally invasive soft tissue thickening, eliminates the risk of suture loosening, reduces procedural difficulty, is easy for doctors to perform, and provides a more comfortable surgical experience for patients. Compared to FGG and CTG, it avoids excessive removal of soft tissue, thereby reducing postoperative pain, bleeding, and other reactions. Unlike the root-oriented repositioned flap, this technique not only widens the attached gingiva but also thickens the gingival tissue. In other words, Pin can maximize the benefits for patients with lip and buccal soft tissue defects within a relatively short surgical time.Conducting further investigations with larger sample sizes and rigorous methods is crucial for validating and extending our finding.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eKMW:\u003c/strong\u003eKeratinized mucosa width\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFGG:\u003c/strong\u003eFree gingival graft\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eARF:\u003c/strong\u003eApically repositioned flap\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTM:\u003c/strong\u003eSoft tissue substitute materials\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCTG:\u003c/strong\u003eConnective tissue graft\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSCTG:\u003c/strong\u003eSubepithelial connective tissue graft\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSFGG:\u003c/strong\u003eSimplified free gingival graft\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGBR:\u003c/strong\u003eGuided bone regeneration\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the West China Hospital of Stomatology Institute Review Board (WCHSIRB)(approval number:WCHSIRB-CT-2024-438).All participants provided informed consent to participate in the study.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for the publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor’s contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY. Wang and P. Luo Image collection and case providers, article writing. Yan Wang, Yingxin Chen, Man Fu, Youhao Chen, Yanlin Ren, case providers. Quan Yuan, Bo Shao critical review of the manuscript. Boxi Fan and Yang Yao: method maker and critical review of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShahramian K, Gasik M, Kangasniemi I, et al. Zirconia implants with improved attachment to the gingival tissue. Journal of periodontology. 2020;91(9):1213-1224.\u003c/li\u003e\n\u003cli\u003eMonje A, Blasi G. Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers. Journal of periodontology. 2019;90(5):445-453.\u003c/li\u003e\n\u003cli\u003eAraujo MG, Lindhe J. Peri-implant health. 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Three-dimensional changes of a porcine collagen matrix and FGGs for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study. International journal of implant dentistry. 2023;9(1):13.\u003c/li\u003e\n\u003cli\u003eBasegmez C, Ersanli S, Demirel K, et al. The comparison of two techniques to increase the amount of peri-implant attached mucosa: FGGs versus vestibuloplasty. One-year results from a randomised controlled trial. European journal of oral implantology. 2012;5(2):139-145.\u003c/li\u003e\n\u003cli\u003eTunkel J, de Stavola L, Khoury F. Changes in soft tissue dimensions following three different techniques of stage-two surgery: a case series report. The International journal of periodontics \u0026amp; restorative dentistry. 2013;33(4):411-418.\u003c/li\u003e\n\u003cli\u003eHan CY, Wang DZ, Bai JF, et al. Peri-implant keratinized gingiva augmentation using xenogeneic collagen matrix and platelet-rich fibrin: A case report. World journal of clinical cases. 2021;9(34):10738-10745.\u003c/li\u003e\n\u003cli\u003eKeddar M, Evrard L, Shall F. Horizontal ridge augmentation using guided bone regeneration with an association of particulate allografts mixed with platelet-rich fibrin, collagen membrane and tent-screws: A prospective study. Journal of stomatology, oral and maxillofacial surgery. 2024;125(12 Suppl 2):101872.\u003c/li\u003e\n\u003cli\u003eWang S, Chen X, Wu W, et al. Tenting Screw Technique for Horizontal Alveolar Bone Augmentation in the Anterior Maxilla: A 1- to 5-Year Retrospective Study. Clinical oral implants research. 2025;36(7):821-834.\u003c/li\u003e\n\u003cli\u003eReddy TS, Shah NR, Roca AL, et al. Space Maintenance Using Tenting Screws in Atrophic Extraction Sockets. The Journal of oral implantology. 2016;42(4):353-357.\u003c/li\u003e\n\u003cli\u003eHempton TJ, Fugazzotto PA. Ridge augmentation utilizing guided tissue regeneration, titanium screws, freeze-dried bone, and tricalcium phosphate: clinical report. Implant dentistry. 1994;3(1):35-37.\u003c/li\u003e\n\u003cli\u003eBerberi A, Nader N, Noujeim Z, et al. Horizontal and vertical reconstruction of the severely resorbed maxillary jaw using subantral augmentation and a novel tenting technique with bone from the lateral buccal wall. Journal of maxillofacial and oral surgery. 2015;14(2):263-270.\u003c/li\u003e\n\u003cli\u003eLee WP, You JS, Oh JS. Technical Note on Simplified FGG Using Tack Fixation (sFGG). Medicina (Kaunas, Lithuania). 2023;59(12).\u003c/li\u003e\n\u003cli\u003eJankowski T, Jankowska A, Palczewska-Komsa M, et al. Patient Experience and Wound Healing Outcomes Using Different Palatal Protection Methods After FGGs: A Systematic Review. Journal of functional biomaterials. 2024;15(12).\u003c/li\u003e\n\u003cli\u003eMoslemi N, Rahami M, Shokri M, et al. Utilization of Buccal FGG to Restore the Peri-Implant Soft Tissue Texture and Color Match in the Esthetic Zone: A Case Report With 3\u0026thinsp;Years Follow-Up. Clinical case reports. 2025;13(8):e70781.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"soft tissue augmentation, minimally invasive,sutureless, mouth mucosa, oral surgical procedures","lastPublishedDoi":"10.21203/rs.3.rs-9151534/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9151534/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003c/em\u003edequate keratinized mucosa thickness is essential for the long-term health and esthetics of the peri-implant area. All along, for patients with soft tissue defects, FGG is the most commonly used treatment method. Although it can achieve better therapeutic effects, it also causes significant secondary injury areas.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eTo achieve minimally invasive soft tissue augmentation without sutures, using tent pins to fix the soft tissue and ensure more reliable tissue stabilization.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eThis article describes a novel soft tissue augmentation technique that replaces conventional FGG with a combination of bone trephine and tack fixation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eAll patients with this technique showed an improvement in their keratinized mucosal thickness in 1 month. No complications were observed, and all cases achieved tension-free healing and aesthetic outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003ePin technique has emerged as a reliable and predictable minimally invasive treatment approach for addressing insufficient peri-implant keratinized gingiva.\u003c/p\u003e","manuscriptTitle":"Ａ Novel Technique of Tacking Free Gingival Flaps to Soft Tissue Augmentation Surgery(Pin technique)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 05:30:36","doi":"10.21203/rs.3.rs-9151534/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T16:41:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-17T15:24:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-17T05:44:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118242440876004604803320727136454584969","date":"2026-05-13T11:22:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205591461408008399495983042179364268536","date":"2026-05-12T12:18:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74245791400365391633802833466693753757","date":"2026-05-12T06:29:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20052284513944275997895789565283650767","date":"2026-05-12T03:58:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164705575156847621647855306043030257400","date":"2026-04-21T04:03:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T22:29:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T11:21:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254713059277844855279044807335928678104","date":"2026-04-11T08:18:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223605809728984837116794679871570462115","date":"2026-04-09T09:43:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T06:44:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T06:42:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-24T15:14:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T15:57:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-03-23T14:03:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7dda717e-1f46-48b3-ae9b-0adf75bb56f3","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T16:41:04+00:00","index":146,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-17T15:24:11+00:00","index":145,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-17T05:44:49+00:00","index":144,"fulltext":""},{"type":"reviewerAgreed","content":"118242440876004604803320727136454584969","date":"2026-05-13T11:22:25+00:00","index":141,"fulltext":""},{"type":"reviewerAgreed","content":"205591461408008399495983042179364268536","date":"2026-05-12T12:18:48+00:00","index":140,"fulltext":""},{"type":"reviewerAgreed","content":"74245791400365391633802833466693753757","date":"2026-05-12T06:29:12+00:00","index":137,"fulltext":""},{"type":"reviewerAgreed","content":"20052284513944275997895789565283650767","date":"2026-05-12T03:58:57+00:00","index":135,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T05:30:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 05:30:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9151534","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9151534","identity":"rs-9151534","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}