A Novel Surgical Technique for Maxillary Alveolar Sealing: Use of a Tunneled Pedicled Connective Tissue Flap in Ridge...

This case report illustrates the use of a novel design for a tunneled connective tissue pedicled flap in socket sealing for guided bone regeneration procedures, specifically in the management of compromised sockets. The purpose of this flap is to optimize soft tissue healing and esthetics in these situations, permitting primary closure without buccal flap advancement. Initially, after creating the surgical access with a sulcular and a mesial releasing incision, extraction of the fractured tooth and immediate implant placement were performed. A xenograft and collagen membrane were then placed. Subsequently, a tunnel pedicled connective tissue flap was created on the palate and rotated to the buccal, covering the collagen membrane. This approach avoided the need for an additional distal releasing incision, which may compromise a source of blood supply, thereby decreasing tissue nutrition and potentially resulting in loss of vestibular depth. The tunnel allowed for positioning the pedicled connective graft submucosally, maintaining access to the blood supply via the base. The healing of the soft tissues was uneventful with adequate vascularization and rapid epithelialization. After 3 months, reentry was performed using a circular scalpel, and an implant-supported provisional prosthesis was delivered. After 30 days of tissue conditioning, a ceramic crown was placed over the osseointegrated implant, resulting in a satisfactory esthetic outcome. The new flap design, called the tunneled pedicled connective tissue flap, proved effective for alveolar soft tissue sealing, providing adequate nutrition in guided bone regeneration procedures for compromised sockets. Prospective clinical studies with longer follow-up periods are needed to understand better the potential use of this new flap design for alveolar socket sealing and alveolar ridge preservation procedures on a routine basis.