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Case Reports
. 2017 Jul-Aug;21(4):333-336.
doi: 10.4103/jisp.jisp_87_17.

Applications of a modified palatal roll flap in peri-implant soft-tissue augmentation - A case series

Mihir Raghavendra Kulkarni  1 , Purva Vijay Bakshi  2 , Abhishek Somanath Kavlekar  2 , Srinath Lakshman Thakur  1
Affiliations
Case Reports

Applications of a modified palatal roll flap in peri-implant soft-tissue augmentation - A case series

Mihir Raghavendra Kulkarni et al. J Indian Soc Periodontol. 2017 Jul-Aug.

Abstract

Abrams's palatal roll technique has been used extensively to augment peri-implant soft tissues in the maxillary esthetic zone and has seen numerous modifications. An adaptation of the palatal roll technique is described here and its simplicity of application in three different scenarios is demonstrated. At second-stage implant surgery, a partial thickness initial incision followed by a palatal subepithelial dissection at the site of implant was done and a connective tissue graft with a buccal pedicle was obtained. The graft was rolled under the buccal flap and allowed to heal with the support of a healing abutment. The graft healed uneventfully and provided excellent contours of tissues around the implant. The procedure demonstrated good results for augmentation of a buccal ridge deficiency, for covering exposed and unsightly implant fixtures and was also done with a papilla preservation incision. In addition, a second surgical site to obtain the connective tissue graft was avoided.

Keywords: Alveolar ridge augmentation; connective tissue graft; dental implants; esthetics; gingival recession.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Site of implant placement showing a buccal ridge deficiency
Figure 2
Figure 2
Line diagram showing the planned incisions
Figure 3
Figure 3
Partial thickness palatal flap raised to uncover the connective tissue bed
Figure 4
Figure 4
Pedicled connective tissue graft raised with a periosteal elevator
Figure 5
Figure 5
Connective tissue graft displaced to the buccal aspect of the implant
Figure 6
Figure 6
Primary closure obtained using braided silk sutures with a healing abutment in place
Figure 7
Figure 7
Healing of the site as seen 1 month after the procedure
Figure 8
Figure 8
(a) Tissue contours as seen 1 year after the procedure (b) Occlusal view of ridge contour 1 year after the procedure
Figure 9
Figure 9
(a) Buccal soft-tissue deficiency at implant site; (b) Papilla preserving incision used and palatal connective tissue pedicle graft obtained; (c) Occlusal view of augmented soft tissue around the healing abutment; (d) Final prosthesis with an augmented zone of keratinized mucosa and maintained papillae
Figure 10
Figure 10
(a) Implant fixtures visible through thin alveolar mucosa; (b) Modified palatal roll technique used to obtain soft-tissue augmentation; (c) 1-month recall picture showing augmented labial tissue and the implant fixtures are no longer visible; (d) One-year recall photograph
See this image and copyright information in PMC

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