The four‐layer graft technique, a hard and soft tissue graft from the tuberosity in one piece

Abstract

Objective Successful immediate implant placement in the maxillary anterior zone continues to be a challenge. There is an uncertainty on whether it should be performed on patients with thin gingival phenotype or incomplete buccal plate. This clinical case report describes a novel technique for immediate implant placement with simultaneous hard and soft tissue augmentation. Clinical considerations This technique employs a combined epithelialized‐subepithelialized connective tissue graft and cortical‐cancellous autogenous bone graft for the treatment of incomplete buccal plate at an extraction site. Significant horizontal bone regeneration appears to have been achieved as well as soft tissue augmentation for a central incisor in a single surgical step. Following three and a half years, gingival contours and bone augmentation were stable with a pleasant esthetic result. Conclusions The use of the four‐layer tissue graft for immediate implant placement can be suggested to improve hard and soft tissues in a single procedure. Clinical significance The use of the four‐layer graft technique has shown to be successful regarding function and esthetic outcomes in anterior immediate implant placement. It reduces surgical interventions and treatment time and minimizes soft tissue recession and bone resorption.

Immediate ridge reconstruction with a composite tuberosity graft after removal of failing implants

“…9 Furthermore, the connective tissue attached to the bone in CTBG may be used to reconstruct the damaged buccal soft tissue. 10,11 This connective tissue also seals the socket and protects the graft when used for socket preservation/reconstruction after tooth and implant removal. 2,12,13 In the present study, the epithelium was retained on the exposed portion of the CTBG to provide greater stability.…”

“…The cortical portion of the graft provides structural support, while the cancellous part has osteogenic, osteoinductive, and osteoconductive properties 9 . Furthermore, the connective tissue attached to the bone in CTBG may be used to reconstruct the damaged buccal soft tissue 10,11 . This connective tissue also seals the socket and protects the graft when used for socket preservation/reconstruction after tooth and implant removal 2,12,13 .…”

The Aesthetic Contour Graft ‐ Enhancing peri‐implant soft tissue contours and pontic sites with guided bone regeneration

“…Traditional methods of enhancing soft tissue thickness and height to create a proper emergence profile around implants mostly involve the use of soft tissue augmentation techniques. [2][3][4] Soft tissue augmentation is beneficial in situations in which there is a thin biotype metal show of the implant collar or for the small vertical augmentation of the soft tissue. However, many periimplant soft tissue deficiencies represent underlying bone defects that can be ideally corrected or enhanced with guided bone regeneration (GBR).…”

“…Even when there is adequate bone in which to place implants, if irregular ridge anatomy supports this tissue and is not corrected, then an unesthetic appearance of the restoration can result due to an inadequate amount of soft tissue with which to develop a proper emergence profile (Figure 1A,B). Traditional methods of enhancing soft tissue thickness and height to create a proper emergence profile around implants mostly involve the use of soft tissue augmentation techniques 2–4 …”

“…Traditional methods of enhancing soft tissue thickness and height to create a proper emergence profile around implants mostly involve the use of soft tissue augmentation techniques. 2 , 3 , 4 …”