Abstract: Adequate attached gingiva around implants is essential for maintaining the long-term success of implant restoration. Clinically, free gingival grafts are widely recognized as the gold standard for augmenting peri-implant attached gingiva, but there is no clear consensus regarding the optimal timing of surgery. This study explores two approaches for attached gingiva augmentation in the posterior mandibular region: prior to implant placement and simultaneously with implant placement. Both approaches demonstrated favorable outcomes. In the latter approach, a digital surgical guide was used to facilitate simultaneous implant placement and attached gingiva augmentation without flap elevation, resulting in predictable outcomes, fewer surgical interventions, reduced patient discomfort, and enhanced clinical efficiency. These findings provide a valuable reference for similar cases in clinical practice.

Key words: Digital surgical guides, Dental implant placement, Attached gingiva augmentation, Timing of surgery guides