“Sliding Full-Thickness Pedicle Flap” for Primary Wound Closure of the Socket Preservation Site

(a) Preoperative periapical radiograph. (b) Initial clinical presentation. (c) Pre-extraction site displaying the extent of the distal edentulous site. (d) Tooth 16 has been removed. (e, f) The “classical” incisions for producing a full-thickness sliding pedicle flap have been made through the distal soft tissue. (g) This schematic depicts the “classical” incisions; the shaded area shows the buccal tissue that will be sacrificed to allow the mesial repositioning of the distal pedicalized flap. (h) Bio-Oss granules have been placed into the socket voids. (i) Bio-Gide membrane is placed over the Bio-Oss. (j, k) The full-thickness mucoperiosteal flap is detached from the underlying bone and repositioned over the Bio-Gide membrane that covers the extraction socket. Suturing has been carried out using 5.0 Prolene (Ethicon, Johnson and Johnson, Somerville, NJ). (l) Socket preservation site at 3-weeks postop, prior to suture removal. (m, n) Socket preservation site at 5-months postop. (o) Periapical radiograph of site at 5-months postop.

(a, b) Site 17 and 16 prior to removal of tooth 16. (c, d) Tooth 16 has been removed. (e) Outline of the distal incisions. (f, g) Full-thickness mucoperiosteal flap has been fully reflected, having removed the V-shaped sacrificial tissue from the buccal wall of the 16 socket. (h) Bio-Oss granules have been placed into the socket voids and the buccal dehiscence. (i) Bio-Gide membrane over the socket site. (j, k) The distal flap has been repositioned mesially and secured over the Bio-Gide/socket using 5.0 Prolene. (l, m) Socket preservation site 16 at 5-months postop. (n) Periapical radiograph of site 16 prior to implant placement. (o, p) Minimal full-thickness flap reflection at site 16 to demonstrate the extent of the preserved socket site during implant placement.