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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.