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Correction of Buccal Fenestration Defects

Aesthetic Flap Design

Flapless immediate implant surgery has been proposed as a means of reducing the surgical trauma to soft tissue and maintaining natural gingival anatomy. The aesthetic outcome in such cases may, however, be jeopardized when localized horizontal and vertical deficiencies occur. In order to correct such deficiencies, a novel flap design was developed that protected the soft tissue that had the most significant impact on the patient's appearance. This aesthetic buccal flap (ABF) was created coronally so that the supraosseous soft tissue remained undisturbed and allowed the use of guided bone regeneration techniques to correct the apical dehiscences. The likelihood of obtaining an optimal aesthetic result was, therefore, enhanced.

*Adjunct Assistant Professor of Oral and Maxillofacial Surgery, Boston University, Boston, massachusetts; private practice, Heidelberg, Germany


Learning Objectives:

This video presents a method to correct apical dehiscences using an ABF. Upon completion of this video, the viewer should:

  • Be aware of a clinical protocol that applies an ABF to correct buccal apical fenestration.
  • Recognize the criteria for performing an ABF procedure.


Related Reading:

  1. Belser UC. Esthetic aspects in implant dentistry. In: Lang NP, Karring T, Lindhe J, eds. Proceedings of the 3rd European Workshop on Periodontology. Carol Stream, IL: Quintessence Publishing; 1999:304-332.
  2. Atwood DA. Post-extraction changes in the adult mandible as illustrated by microradiographs of mid-sagittal sections and serial cephalometric roentgenographs. J Prosthet Dent 1963;13:810-816. 
  3. Atwood DA. Some clinical factors related to rate of resorption of residual ridges. J Prosthet Dent 2001;86(2):119-125.
  4. Salama H, Salama MA, Garber D, Adar P. The interproximal height of bone: A guidepost to predictable aesthetic strategies and soft tissue contours in anterior tooth replacement. Pract Periodont Aesthet Dent 1998;10(9):1131-1141.
  5. Wang HL, Shotwell JL, Itose T, Neiva RF. Multidisciplinary treatment approach for enhancement of implant esthetics. Impl Dent 2005;14(1):21-29.
  6. Bichacho N, Landsberg CJ. Single implant restorations: Prosthetically induced soft tissue topography. Pract Periodont Aesthet Dent 1997;9(7):745-752.
  7. Steigmann M, Daum O. Diagnosis in implant esthetics [in German]. Implantol J 2004;75(3):50-52.
  8. Steigmann M. Aspects of implant esthetics [in German]. Cosmet Dent 2004;2:30-32.
  9. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995-996.
  10. Garber DA, Salama MA, Salama H. Immediate total tooth replacement. Compend Contin Educ Dent 2001;22(3):210-216.
  11. Hahn J. Single-stage, immediate loading, and flapless surgery. J Oral Implantol 2000;26(3):193-198.
  12. Campelo LD, Camara JR. Flapless implant surgery: A 10-year clinical retrospective analysis. Int J Oral Maxillofac Impl 2002;17(2):271-276.
  13. Rocci A, Martignoni M, Gottlow J. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: A retrospective 3-year clinical study. Clin Impl Dent Relat Res 2003;5(suppl 1):29-36.
  14. Schwartz-Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: A literature review. J Periodontol 1997;68(10):915-923.
  15. Wöhrle PS. Single-tooth replacement in the aesthetic zone with immediate provisionalization: Fourteen consecutive case reports. Pract Periodont Aesthet Dent 1998;10(9):1107-1114.
  16. Wang HL, Misch C, Neiva RF. “Sandwich” bone augmentation technique: Rationale and report of pilot cases. Int J Periodont Rest Dent 2004;24(3):232-245. 
  17.  Steigmann M. Pericardium membrane and xenograft particulate grafting materials for horizontal alveolar ridge defects. Impl Dent 2006;15(2):186-191.
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