Introduction: The presence of adequate keratinized mucosa (KM) around dental implants and natural

dentition is pivotal for the long-term success of dental restorations. Despite various techniques to

augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in

the context of significant muscle pull or compromised tissue conditions. This study introduces a novel

application of titanium pins for the fixation of free gingival grafts (FGG) and apically repositioned

flaps (APF) during vestibuloplasty, aiming to overcome important limitations associated with

traditional suturing methods and shorten the treatment time and patient morbidity. Methods: Three

patients with insufficient KM width, presenting discomfort during oral hygiene and inflammation

around implant restorations and natural teeth, underwent soft tissue augmentation using titanium pins

traditionally used in guided bone regeneration (GBR) for the stabilization of FGGs and APFs. This

method ensures intimate contact between the graft and the periosteum, facilitating proper graft

perfusion and revascularization, minimizing shrinkage and the risk for necrosis of the graft. Results:

Postoperative follow-up revealed successful integration of the grafts, with minimal shrinkage and

increased width and depth of KM. The use of titanium pins allowed for reliable fixation in challenging

surgical sites, where traditional suturing methods were impractical due to the presence of extensive

muscle pull and an unstable recipient bed. Conclusion: The application of titanium pins for the fixation

of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing

techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This

method simplifies and shortens the procedure, offering a predictable outcome with increased

mechanical stability and minimal shrinkage of the graft. Randomized clinical trials are recommended

to further evaluate the efficacy of this technique.