The palatal advanced flap: a pedicle flap for primary coverage of immediately placed implants

The placement of implants immediately after tooth extraction has become a relatively common event. This approach has gained popularity because it reduces the time between tooth extraction and placement of the final prosthetic restoration. One problem that remains unresolved with this procedure, however, is that there is usually space left in the area surrounding the coronal portion of the implant. As none of the techniques published to date is completely satisfactory, we developed an approach that is a modification of the palatal pedicle flaps used for closure of oro-antral fistulas. This technique allows for precise rotational advancement of the palatal tissue in a coronal direction, thus facilitating complete coverage of the extraction site. The procedure was used on 38 patients treated for primary coverage of postextraction placed implants. Thirty-two of the patients required single tooth replacement, three patients received two implants each, and three patients received three implants each. In 27 of the cases, the procedure was performed in conjunction with barrier membranes; of the 38 cases, 25 patients required the use of DFDBA to fill the defect created by the extraction procedure. The average defect width was 4.70 +/- 0.2 mm. Complete primary coverage was obtained in all cases without any changes in the size or anatomy of the buccal vestibule; complete coverage was maintained over the entire healing period of 6-8 months (mean +/- SEM, 6.49 +/- 0.10 months). Even with guided tissue regeneration cases, there was no exposure of the barrier membrane or cover screw of the implant during healing. After a period of 1-5 years (mean +/- SEM, 39.35 +/- 2.69 months), none of the implants was lost. We conclude that the palatal advanced flap procedure is useful, fast, and easy to perform in cases of immediate implant placement after tooth extraction.