Modified Roll Palatal Flap Technique in Aesthetic Zone. Stability of Results After 4 years
A case of oligodontia with several congenitally missing teeth is presented. Implant therapy using modification of Abrams’s roll technique was used to correct the localized alveolar ridge deficiency on #7 and #10 areas. A crown was used to immediately provisionalize the implants after flap elevation.
Abrams was the first to describe the ‘’roll’’ technique on the 1980. According to this method, a deepithelialized palatal flap was dissected and a pedicle was displaced toward the buccal aspect of the implant site. The connective tissue pedicle was then rolled below the buccal flap in the area of the deformity, in order to correct buccolingual ridge defects.
On the 1992 Sharf introduced modification of Abram’s technique.
Several case series have then reported that it is indeed possible to increase the soft tissue thickness and the amount of keratinized tissue with the palatal roll technique. Interestingly though, none of these reports in the literature has a follow-up period of more than 2 years.
The purpose of the this clinical report is to present a 4-year follow up of two implant supported crowns and adjacent soft tissues, optimized using the Abram’s modified roll palatal technique.
A 22 year old Caucasian male presented with a maxillary removable partial denture, replacing the congenitally missing lateral incisors and also teeth # 12,13. Patient requested the replacement of his missing teeth with dental implants. His medical, surgical and social history was non-contributory. During the clinical examination, the patient presented with diastema between teeth #8 and #9 and inadequate mesiodistal space for implants placement in the areas of #7 and 10. The mesiodistal distance between #6 and #8 and between #11 and #9 before treatment was 6 mm and 6.1 mm respectively. Therefore, orthodontic treatment was planned. After four weeks of orthodontic treatment, the diastema between #8 and #9 was closed and the edentulous space between the teeth #6 and #8 and #9 and #11 measured 7.2mm and 7.7mm respectively.
Two bone level implants of diameter 4.1mm and 10mm length were placed in the sites of #7 and #10. After a healing period of 6 weeks augmentation of the buccal site of #7 and #11 was planned, using the modified roll palatal flap technique. Two diverging vertical releasing incisions of 5 mm in length were performed on the buccal and palatal aspects of the implant site. The incisions were submarginal in design and located 2 mm away from the gingival margin, in order to preserve the papillae and the periodontal attachment of the adjacent teeth. They were then joined by split-thickess incision along the crest of the ridge and used as starting point for reflection of the palatal epithelial pedicle then turned into a full-thickness flap. A full thickness flap was then reflected towards the buccal until the end of the vertical releasing was reached. The palatal flap was rolled and inserted between the buccal plate and the buccal flap.
Following the augmentation, immediate provisionalization was achieved with pre-formed polycarbonate crowns. Six weeks after definitive cement-retained full-ceramic restorations were delivered. Pre and post op pictures and x-rays will be presented year-by-year showing the aesthetic outcome and results stability.
This clinical report indicates that after 4 years of follow up, the modification of Abrams’s roll technique in localized ridge atrophy shows great stability and reliability of the aesthetic results.
Reference
Abrams L. Augmentation of the deformed residual edentulous ridge for fixed prosthesis. Compend Contin Educ Gen Dent 1980 May-Jun;1(3):205-213
Scharf DR, Tarnow DP. Modified roll technique for localized alveolar ridge augmentation. Int J Periodontics Restorative Dent 1992;12(5):415-425