Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft
By: Chang Kim
In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome.
This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double rotated palatal sub-epithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect.
Materials & Methods
We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. An inorganic bovine xenograft (A-Oss, Osstem, Korea) was filled above the alveolar defect and a titanium reinforced non-resorbable membrane was placed to cover the graft material. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture.
Fig. 2. Clinical view; A) The bottom of fissure was located on the arrow tip. B) Note an atrophic incisive papilla (arrow). C) After flap reflection, an end of the defect was approaching in a nearby anterior nasal spine. D) Bone graft material was placed in the defect site, and E) covered by nonresorbable membrane. F) The membrane was stabilized by titanium screw. G) Bone material (A-Oss, Osstem, Korea)
Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment.
The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and
harmonization with the recipient tissue.