Rotated palatal flap in immediate implant procedures. Clinical evaluation of 26 consecutive cases

Immediate implant placement after tooth extraction is a successful treatment modality. Primary flap closure is important for satisfactory final results in these procedures. The purpose of this article was to evaluate a surgical approach that would enable predictable primary soft tissue closure over implants placed into fresh extraction sockets. In 24 patients, 26 consecutive implants were placed immediately following extraction of one anterior or premolar maxillary tooth. Primary closure was achieved by a surgical technique based on a rotated palatal flap (RPF), covering the implant. Deproteinized bovine bone was used as grafting material. The apicocoronal distance between the buccal alveolar crestal bone and the coronal aspect of the implant body was measured at time of implant placement (mean 2.6 mm, SD 1.72) and at second stage surgery (mean 0.6 mm, SD 0.70). The difference between both records was calculated. The mean gain in crestal bone was 2.0 mm (SD 1.69, P < 0.001). In 1 patient, where the implant cover screw became exposed early, crestal bone loss was noted. This technique offers a predictable valuable treatment approach to achieve and maintain primary soft tissue coverage and crestal bone regeneration over implants immediately placed within a bony envelope, after extracting maxillary teeth, without the use of barrier membranes.