Maintaining a 40-Year-Old Trans-mandibular Implant: The Role of Peri-Implant Soft Tissue Grafting

                                                               Rami Kassar , Abdusalam Alrmali, Ahmed Gabir, Berna Saglik, Purnima Kumar

 

 

Introduction:

Severe mandibular atrophy limits conventional implant

rehabilitation, and the transmandibular implant (TMI) was

historically used to stabilize overdentures in such cases. TMIs

persist today as legacy implants in long-term function.

This case report describes a rare 40-year functioning TMI

complicated by peri-implant mucosal deficiency, successfully

managed with free gingival grafting to preserve implant function.

 

Methods:

Following clinical and radiographic confirmation of a stable

transmandibular implant with peri-implant mucositis and

insufficient keratinized mucosa, soft tissue augmentation was

performed. Under local anesthesia, a partial-thickness flap was

elevated to create a vascularized recipient bed, and a 1-mm free

gingival graft harvested from the palate was contoured and

secured with 5-0 monofilament sutures.

A periodontal dressing was applied, and the overdenture was

temporarily discontinued. Postoperative care included

chlorhexidine rinse  a soft diet, and follow-up to monitor graft

integration.

 

Results:

The free gingival graft healed uneventfully with

successful integration. At two weeks, the graft was viable

with early revascularization and increased tissue

thickness. At one-month, keratinized mucosa increased

with resolution of bleeding and improved plaque control.

At 12 months, a stable band of keratinized tissue was

maintained without recurrent mucositis. The

transmandibular implant remained fully functional with

restored overdenture stability and patient satisfaction.

Conclusion:

Soft tissue deficiency, rather than implant failure, may

underlie late complications in long-standing

transmandibular implants. Free gingival grafting

predictably restored peri-implant keratinized mucosa,

resolved inflammation, and preserved implant function.

Even after 40 years, legacy TMIs can be maintained with

targeted soft tissue management, avoiding complex

removal.