Major Palatal Advancement and Dental Implants in Anterior Maxillary Atrophy

The objective of the study was to treat  vertical and antero-posterior maxillary deficiency by inserting dental implants, bone grafting and augmenting soft tissues by advancing a major palatal graft with maintaining the anterior palatine arteries.

Material and Method: 7 patients (17 to 29 y.o.) were treated by a major palatal flap advancement with a transverse incision over the palatine bone to the periosteal layer, around all the teeth and anteriorly in the vestibule.  The anterior palatine bundles were kept intact and meticulously extended with a small  thick hook or periosteal elevator for flap flexibility.  The edentulous space was approached and dental implants were inserted.  Bone grafting from the mandibular ramus and allograft covered with a collagen membrane or impregnated with BMP was positioned. The palatal flap was advanced and secured with several 8 mm long screws to the bone to insure flap stability and eliminate dead space.  Final securing of the flap was completed with interrupted 3-0 vicryl sutures. A running suture was used over surgicell in the palatine bone defect to avoid post-operative bleeding. Implants were uncovered 4 months later and prosthetic work completed.

Results:  All patients had an excess of soft tissue that was progressively treated with provisional teeth molding or minimal gingivectomies. All implants were loaded and ideally dental rehabilitated. No flaps were lost and no fistulas or complications other than initial pain and discomfort were noted.

Conclusions: Major palatal flap advancement offers important keratinized tissues, volume and adequate blood supply for bone graft healing with simultaneous insertion of dental implants.  It is a safe and predictable technique to augment soft tissues and offers good blood supply for bone graft healing with simultaneous dental implant insertion.

 

1. Millard, D.R.  Wide and or short cleft palate. Plastic and Reconstructive Surgery. 1962; 29(1), 40-57
2. Millard, D.R., Seider, H.A.  The versatile palatal island flap: It's use in soft palate reconstruction and nasopharyngeal and choanal atresia. British Journal of Plastic Surgery. 1977; 30(4), 300-305