Vascularized Buccal Inversion Flap

(a) In spite of this robust residual ridge, a slight buccal deficiency in contour is present preoperatively at the apical aspect of the implant site. (b) An omega incision is used to outline the approximate position of the planned implant. (c) The residual ridge is exposed. The slight concavity in the buccal contour is identified. (d) A root form implant is placed. (e) The pedicle flap is prepared by first outlining the buccal circumference of the implant. (f) The flap is further split horizontally creating a 5–6 mm pedicle extension while maintaining vascularity from the buccal mucosa. (g) A healing abutment is placed. The pedicle flap is inverted and tucked into a previously prepared buccal tunnel. (h) The pedicle flap is in position, and there is essentially no movement of the graft. (i) Two chromic gut interrupted sutures are used to position the flap close to the healing abutments. (j) Occlusal view of the sutured site. Very little trauma is present. (k) Buccal view 4 months after surgery. (l) Occlusal view 4 months after surgery in which a fuller buccal contour is evident. (m) Final restoration of the maxillary second premolar implant-supported crown.

(a) Preoperative mirror view of the Div A-w ridge. (b) Omega incision outlining the position of the planned root form implant. (c) A split-thickness incision is made just short of the mucogingival junction. (d) The split thickness extends to the vertical relaxing incisions. (e) The crestal tissue column is further split horizontally. (f) A long pedicle flap is achieved without compromising the palatal slope. (g) The vascularized pedicle flap is inverted toward the buccal mucosa. (h) The pedicle flap is tucked into the previously prepared buccal tunnel. This tunnel will stabilize the connective tissue graft. Sutures are not required to contain the graft. (i) Vascularized buccal inversion flap in position. (j) Healing abutment in place. Two chromic gut interrupted sutures are used to secure the flap close to the healing abutment.