Fibrin immobilization refers to the process of attaching or fixing fibrin molecules to a surface. Fibrin is a protein involved in blood clot formation, and it plays a crucial role in wound healing and tissue repair. Fibrin immobilization in the context of dental implants involves using fibrin to stabilize and support tissue regeneration around the implant site. Fibrin forms a mesh-like structure during the blood clotting process, providing a scaffold for cell attachment and growth. This property makes it beneficial for tissue engineering and regenerative medicine. By immobilizing fibrin around the dental implant, it can enhance cell migration and proliferation, leading to better integration of the implant with the surrounding bone and soft tissues.

Thrombus stability and leukocyte adhesion

The blood clot is composed of fibrin matrix. When leukocytes (such as neutrophils and monocytes) encounter the fibrin clot, they adhere to it via integrins. However, excessive leukocyte adhesion can be detrimental during early wound healing when hemostatic plug integrity is critical. Soluble fibrinogen can protect fibrin from excessive leukocyte adhesion by associating with the fibrin substrate. Leukocytes engaging loosely bound fibrinogen molecules cannot consolidate their grip on the substrate, leading to cell detachment. Enzymes can be immobilized on fibrin surfaces using techniques like glutaraldehyde treatment. This method allows enzymes to remain attached to the fibrin matrix, enabling applications in biotechnology and bioengineering.

Fibrin Immobilization Vestibular Extension (FIVE) technique

FIVE is a technique that integrates the use of fibrin for tissue regeneration with vestibular extension to enhance the outcomes of dental implant procedures. This approach aims to improve both the biological integration of the implant and the surrounding soft tissue aesthetics and functionality. This technique offers a valuable option for peri-implant phenotype modification without the need for additional grafting procedures.

The primary component of this treatment is Platelet-Rich Fibrin (PRF). PRF obtained from patient’s blood is rich in growth factors that promote healing and tissue regeneration. During the implant surgery, PRF is placed around the implant to provide a scaffold for cell attachment, migration, and proliferation, which are crucial for effective healing and integration. In fibrin immobilization vestibular extension, vestibular extension is performed, ensuring adequate protection and stability of the implant, as well as enhancing the aesthetic appearance of the gingiva.

After implant placement, PRF is placed around the implant site to enhance tissue regeneration. PRF acts as a scaffold, supporting cell attachment, migration, and proliferation. Vestibular extension is done by repositioning the soft tissue, ensuring that the vestibular depth and width are sufficient to cover the implant site adequately. If required, releasing and repositioning the periosteum can be done to achieve the desired extension. Flap is then repositioned over the implant and PRF. Flap is securely sutured to ensure proper soft tissue coverage and stability.

Benefits of the FIVE Technique

Enhanced Healing: PRF accelerates the healing process and improves the quality of the regenerated tissue.

Better Integration: Fibrin immobilization supports better osseointegration, leading to a more stable and durable implant.

Improved Aesthetics: Vestibular extension ensures sufficient soft tissue coverage, enhancing the aesthetic outcomes.

Long-Term Stability: The combination of biological and soft tissue management techniques contributes to the long-term success of the dental implant.

Problems and challenges associated with FIVE technique

This procedure requires advanced surgical expertise. Achieving the correct depth and width of the vestibule can be technically challenging, requiring advanced surgical skills to avoid overextension or insufficient extension. Inadequate soft tissue management can lead to gingival recession, exposing the implant and compromising both aesthetics and functionality. The sutured flap may reopen if not properly managed, leading to exposure of the implant and PRF, which can result in contamination and infection. The surgical procedure, particularly during vestibular extension, can inadvertently damage adjacent anatomical structures such as nerves and blood vessels. Even with successful vestibular extension, there may be differences in the color and texture of the grafted tissue compared to the surrounding native tissue, affecting the aesthetic outcome. Surgical intervention can result in visible scarring, which might be a concern, especially in aesthetically critical areas. PRF is a natural material that gradually resorbs over time. Its short-term presence may limit its long-term effectiveness in supporting tissue regeneration. The biological variability in patients’ blood components can affect the quality and efficacy of PRF, leading to inconsistent results.

Hence, it is recommended that the surgical team should be well-trained and experienced in the FIVE technique and its components. Providing detailed post-operative care instructions is very important and patient should be made to understand the importance of these instructions.


The FIVE surgical technique combines fibrin immobilization with vestibular extension to optimize the outcomes of dental implant procedures. By enhancing both the biological integration and soft tissue management, this technique addresses critical factors for the success of dental implants, leading to improved patient satisfaction and long-term stability. By being aware of these potential problems and taking steps to address them, practitioners can enhance the success rates and outcomes of the FIVE technique.

Periobasics: A Textbook of Periodontics and Implantology

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