Pedicle Connective Tissue Graft With Novel Palatal Tunneling

Implant esthetics can be compromised with a lack of hard and/or soft tissue in the anterior maxilla. Soft‐tissue augmentation is often a crucial step in optimizing esthetic outcomes. Palatal pedicle soft‐tissue grafts present a versatile option and have a high survival potential. This case series presents a pedicle connective tissue graft technique with novel palatal tunneling as an additional tool for implant site development. It has multiple indications, including complete socket closure, augmentation of soft‐tissue volume, enhancement of gingival papillae, and treatment of peri‐implant defects. Case Series: In the first case, the pedicle graft was performed to achieve soft‐tissue closure over a socket preservation site that was fully dehisced on the facial aspect. This procedure allowed for protecting the bone graft and developing the soft tissue for implant placement 4 months later. The second case was more challenging because of an ankylosed maxillary central incisor presenting with a severe gingival discrepancy. After tooth extraction and hard‐tissue reconstruction, a pedicle graft was used at the time of implant placement to augment the soft tissue over the facial dehiscence of the implant in combination with a bone graft. Conclusions: The novel palatal tunneling in this technique improved the positioning of the pedicle graft at the recipient site. It also preserved the integrity of the mucosa palatal to the defect site by minimizing the protuberance that resulted at the site of pedicle rotation. Soft‐tissue height and volume were found to be increased.