Journal of Oral Implantology September 2012 - (Page 458)

CASE REPORT Fold-Over Flap Technique for Developing the Facial Gingival Contour: A Case Report Dennis Flanagan, DDS* A dental implant surgical technique is described including a 12-mm fold-over of a facial flap and coapting the internal side of the folded flap with a 4-0 suture. The flap is pulled against a provisional crown with a sling-type suture during the implant uncovery stage and may decrease the risk for a poor esthetic facial gingival architectural outcome. Key Words: dental implant, esthetics, gingival contour, mucosal stability, coapt INTRODUCTION atients with facial cortical bone loss who require dental implant treatment are challenging to treat. The facial bone supports the facial gingiva for an esthetic gingival contour. The facial bone may need to be restored by particulate or block grafting for an appropriate architecture to provide the gingival support. The contention herein is that dense submucosa may be more stable than grafted bone; thus, it may be that reconstructed dense submucosa may be used to create or contribute to an esthetic gingival contour when there is a grafted or unstable facial bone at a single implant site. The technique described herein can create a thick gingival biotype, which may be more stable than grafted bone and create a more esthetic outcome. CASE REPORT P A 61-year-old man had a long-standing missing #9. After decades of wearing a flipper appliance, he desired implant treatment to restore this site. Visual and radiographic examination and bone-sounding ridge mapping was performed, and it was found that the osseous contour was atrophic.1 A course of treatment was decided upon (Figure 1). The site Private practice, Willimantic, Conn. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-11-00064 was locally anesthetized (articaine [Septocaine]), and the narrow osseous ridge was split with a #15 scalpel, D channel former (Tatum Surgical), and #3 and 4 round osteotomes (Figures 2 and 3). The facial cortical bone flap was then displaced to the facial, thus opening a slot that opened access to the deeper area of bone. The osseous flap was deemed inadequate to provide enough volume for appropriate facial gingival support and would be addressed at the uncovery stage. The apical drilling was done between the bone flap and the lingual cortex. A 4-mm 3 15-mm implant (3-I, Palm Beach Gardens, Fla) was placed at 35 Ncm (newton centimeters) torque. The facial bone flap was covered with 250- to 1000-lm particulate corticocancellous allograft (AlloOss) and covered with a resorbable barrier membrane (BioMend), and the site was closed with 4-0 polyglycolic acid sutures (Vicryl; Figure 4). An appropriate denture tooth was festooned and bonded to the adjacent teeth and was used as a provisional prosthesis (Figure 5). After 4 months of uneventful healing, the patient was locally infiltrated anesthetized, and a full-thickness papilla-sparing flap was raised. The flap was 12 mm from the base to the palatal cut edge to allow for a fold-over (Figures 6 and 7). The fold-over had 4 mm facial, 4 mm fold-over, and 4 mm lingual aspects that allow for tissue shrinkage, and it placed the cut edge down to the submucosa at the facial of the implant abutment. The folded-over flap was sutured by running a 4-0 polyglycolic acid (Vicryl) suture through the mesial apical corner of the flap 458 Vol. XXXVIII /Special Issue No. One /2012

Table of Contents for the Digital Edition of Journal of Oral Implantology September 2012

American Academy of Implant Dentistry Foundation Supports Basic and Clinical Research
Evaluation of 3- to 8-Year Treatment Outcomes and Success Rates With 6 Implant Brands in Partially Edentulous Patients
Histometric Analysis of Bone Repair in Bone-Implant Interface Using a Polylactic/ Polyglycolic Acid Copolymer Associated With Implants in Rabbit Tibia
Fold-Over Flap Technique for Developing the Facial Gingival Contour: A Case Report
Rehabilitation of the Atrophic Posterior Maxilla With Pterygoid Implants: A Review
Immediate Loading of Maxillary and Mandibular Implant-Supported Fixed Complete Dentures: A 1- to 10-Year Retrospective Study
Immediate Loading of Single Post-Extractive Implants in the Anterior Maxilla: 12-Month Results From a Multicenter Clinical Study
Immediate Implants After Enucleation of an Odontogenic Keratocyst: An Early Return to Function
Effects of Different Abutment Connection Designs on the Stress Distribution Around Five Different Implants: A 3-Dimensional Finite Element Analysis
Implant-Prosthetic Rehabilitation of a Patient with Nonsyndromic Oligodontia: A Clinical Report
Planning for Immediate Loading of Implant-Supported Prostheses: Literature Review
Development of a Rat Model of Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)
Anorganic Bovine-Derived Hydroxyapatite vs β-Tricalcium Phosphate in Sinus Augmentation: A Comparative Histomorphometric Study
Peripheral Giant Cell Granuloma Associated With Dental Implants: Clinical Case and Literature Review
Bilateral Vertical Ridge Augmentation With Block Grafts and Guided Bone Regeneration in the Posterior Mandible: A Case Report
Cell Culture–Based Tissue Engineering as an Alternative to Bone Grafts in Implant Dentistry: A Literature Review

Journal of Oral Implantology September 2012