4-layer Graft for Bone and Soft-tissue Augmentation At Healed Sites: a Case Report

This case report introduces a novel 4-Layer Graft technique for simultaneous bone and soft-tissue augmentation, harvested from the maxillary tuberosity (MT) utilizing a harvesting protocol adapted from the immediate dentoalveolar restoration (IDR) technique. The 4-Layer Graft is a composite graft containing a cortical bone layer, a cancellous bone layer, a periosteum with connective tissue, and an epithelial layer (keratinized mucosa). Its uniqueness lies in offering a single-stage solution for combined hard and soft tissue deficiencies at healed alveolar ridge sites. Clinical findings included healed sites presenting with significant horizontal and partial vertical bone defects alongside notable soft-tissue deficiencies. The therapeutic intervention involved applying the 4-Layer Graft in a single-stage procedure. Outcomes at three months demonstrated substantial horizontal bone gain (4 mm), significant keratinized tissue width increase (4 mm), and soft tissue thickness gain (1.5 mm). Implant placement and subsequent healing occurred without complications. The 4-Layer Graft technique offers a promising and efficient single-stage solution for comprehensive bone and soft-tissue augmentation, effectively preparing deficient healed sites for successful implant placement and predictable esthetic outcomes. This approach presents a valuable advancement for managing complex ridge defects.