Rotated pedicled palatal flaps for primary closure in immediate post-extractive guided bone regeneration at maxillary molar locations: A case report of a new technique.

Abstract

Background: Replacing severely compromised teeth with endo-periodontal lesions continues to pose a clinical challenge because of accompanying deficiencies in hard and soft tissues. While traditional staged protocols, involving vertical ridge augmentation and soft tissue grafting, are effective, they are complex, time-intensive, and often not well-received by patients. This case report presents a simplified approach that combines immediate guided bone regeneration (GBR) using a rotated pedicled palatal flap to achieve primary closure without requiring buccal flap advancement, thereby preserving vestibular depth and keratinized mucosa.

Methods: Two systemically healthy, non-smoking male patients with grade 3 endo-periodontal lesions in the maxillary molar area underwent flapless extraction. This was followed by immediate guided bone regeneration (GBR) using deproteinized bovine bone mineral and a resorbable collagen membrane, which was sealed with a pedicled palatal flap. In both instances, this technique successfully stabilized the graft and achieved primary wound closure.

Results: Implant placement was performed 6 months later with minimal intervention required. Follow-up evaluations at 3 years showed stable peri-implant tissues, satisfactory esthetic integration, and high patient satisfaction.

Conclusion: This technique provides a viable alternative for the immediate reconstruction of severely compromised sockets when immediate implant placement is not feasible, minimizing surgical morbidity while maximizing soft tissue preservation. Further research is needed to validate its long-term efficacy and broader clinical applicability.

Key points: The adoption of a rotated pedicled palatal flap can enable immediate GBR without buccal flap advancement, allowing primary closure while preserving vestibule depth and the existing width of keratinized mucosa. This simplified single-stage approach can reconstruct hard and soft tissues simultaneously in severely compromised extraction sockets where immediate implant placement is not possible, reducing treatment complexity, costs, and morbidity. Clinical outcomes at 3 years showed stable peri-implant tissues, minimal need for secondary interventions, and high patient satisfaction, suggesting this technique may offer a predictable and patient-friendly alternative to traditional staged protocols.

Plain language summary: When a tooth is severely damaged by both infection and bone loss, dentists often need to remove it and rebuild the area before placing a dental implant. Traditional treatment usually requires several complex surgeries to restore bones and gums, which can be time-consuming and uncomfortable for patients. In this report, we describe a simpler, less invasive approach that allows reconstruction of both bone and gingiva after the extraction of a severely damaged tooth. After removing the damaged tooth, the empty socket was filled with a bone substitute material and covered with a thin connective tissue layer taken from the patient's own palate. This layer acted like a natural bandage, protecting the graft and allowing the area to heal without pulling or stretching the gum tissue. Six months later, dental implants were placed and remained stable over a 3-year follow-up period. The patients were pleased with the results and experienced minimal discomfort. This method may offer clinicians a straightforward and patient-friendly option to rebuild bone and gum tissue at the same time in difficult cases, although larger studies are needed to confirm its long-term success.