The S-technique: A Novel Dense Polytetrafluoroethylene-assisted Surgical Technique for Peri-implant Keratinized Mucosa Preservation - A Case Review.

Abstract

ABSTRACT Immediate implant placement following tooth extraction often leads to peri-implant defects that require guided bone regeneration (GBR) to achieve complete bone fill and stable osseointegration. Conventional GBR techniques typically rely on primary flap closure, coronal advancement, and additional soft-tissue grafting, which increase surgical complexity and patient morbidity. The S-Technique was introduced to enable simultaneous hard and soft-tissue regeneration under open-healing conditions while preserving the mucogingival junction. A patient presented with a grossly decayed, painful, vertically fractured, nonrestorable maxillary right second premolar (tooth 15). After atraumatic extraction and immediate implant placement, a peri-implant gap defect with limited soft-tissue availability was noted. GBR was performed using particulate xenograft and a resorbable collagen membrane. A dense polytetrafluoroethylene membrane was then placed according to the S-technique protocol, allowing secondary epithelialization without primary closure. Healing progressed uneventfully. At 4 months, clinical assessment showed complete coverage of the peri-implant site, an adequate band of keratinized mucosa, improved soft-tissue contour, a favorable emergence profile, and stable peri-implant architecture. Prosthetic rehabilitation resulted in satisfactory esthetic and functional outcomes with maintained bone support. This case demonstrates the S-Technique as a minimally invasive dual-layer membrane approach for simultaneous hard and soft-tissue regeneration around immediate implants. By eliminating the need for primary closure and autogenous soft-tissue grafting, it offers a predictable alternative for managing peri-implant defects in sites with limited soft-tissue availability, while promoting keratinized mucosa formation and stable peri-implant tissue integration.