Rotated split palatal flap for soft tissue primary coverage over extraction sites with immediate implant placement. Description of the surgical procedure and clinical results.

Abstract

Immediate implant placement after tooth extraction is becoming a common procedure in implant-supported oral rehabilitation. However, lack of primary full flap closure can jeopardize final results. A surgical approach that would enable predictable primary soft tissue closure over implants placed into fresh extraction sockets is described and evaluated. This technique is based on a rotated deep split thickness palatal flap (RSPF) containing periosteum and connective tissue, covering the implant and/or a barrier membrane. In 29 patients, 33 consecutive implants were placed immediately post extraction of 1 or 2 anterior or premolar maxillary teeth. Patients were divided in 2 groups: Group A (15 patients; n = 18 sites) where no barrier membrane was used and Group B (14 patients, n = 15 sites) where an occlusive resorbable collagen membrane was used. Distance between the alveolar crestal bone and the coronal aspect of the implant was measured at time of implant placement (Group A: mean 1.9 mm, SD 1.16; Group B: mean 4.6 mm, SD 1.18) and at second stage surgery (Group A: mean 0.3 mm, SD 0.46; Group B: mean 0. 7 mm, SD 0. 7). The difference between both records (crestal bone formation) was calculated (Group A: 1.7 mm, SD 1.03; Group B: 3.9 mm, SD 1.12) and found to be statistically significant (P <0.0001). Crestal bone formation, relative to the initial bone crest-implant distance at time of implant placement was approximately 85% in both groups. In 4 sites (2 in each group), where the cover screws were exposed before second stage surgery, complete crestal bone regeneration did not occur. Use of a barrier membrane may be obviated in appropriate cases while placing implants into fresh extraction sites. This procedure offers a predictable treatment approach in achieving complete soft tissue coverage, while allowing for healing of bony defects in immediate implantation procedures.