A tissue punch is a simple and easy way to gain access to underlying bone for dental implant placement. It is generally used when there is  excellent ridge width and there will be no bone needed and excellent keratinized gingiva, and  good access to place the punch. Tissue punches are available in five different diameter sizes (3.5mm, 4.0mm, 4.5mm, 5.0mm, 5.5mm).