The rotated pedicle palatal connective tissue flap technique (RPPCTF) in management of soft tissue defects

Abstract

Introduction. Esthetic and functional reconstruction of soft tissue in maxilla have driven the evolution of plenty of techniques for rehabilitation. Selection of a proper surgical technique often causes difficulties. The closer the flap donor site is to the defect; the less morbidity is associated with the reconstructive surgery. The RPPCTF technique present a multilateral application. It can be used in closure of the alveolus after immediate implant placement, complete socket closure, increasing soft-tissue volume, papilla reconstruction, defects and dehiscence repair, closure of oro- antral communication (OAC). Aim of the study. Evaluation of the soft tissue reconstruction technique for covering defects associated with maxillary region. Materials and methods.. This study was axed on 7 patients which represent the different types of soft and bone tissue defects in maxillary aesthetic zone. In 3 cases this technique was performed to complete socket closure and postponed implant placement. Closure of oro-antral communication was performed at 1 patient, closure of the alveolus after immediate implant placement was performed in 3 cases. After local anesthesia and a minimally invasive extraction of tooth, the socket was curetted and inspected. The dimensions of the socket were measured and considered for RPPCTF technique preparation. A single palatal incision (Hurzeler MB, Weng D.) design was placed, pedicle graft was prepared leaving the mesial side attached, then is checked for freedom of movement, rotation and placement. The pedicle graft is rotated and positioned over the edentulous area and onto the buccal surface. After that the flap are sutured using horizontal mattress and simple interrupted sutures. The donor site remains primarily covered. Results. During treatment with this method partial flap necrosis did not occur. All patients showed a significant improvement over the preoperative condition. In all cases we got a large volume of soft tissue, excellent esthetic results, primary socket closure. RPPCTF can help to preserve or restore the natural ridge contours. In addition to providing graft containment, the RPPCTF can also serve as a barrier membrane during bone regeneration. Conclusions. The rotated pedicle palatal connective tissue flap is a relatively simple technique for soft tissue coverage without excessive tension. It is an excellent technique that can be used to improve the vertical and horizontal thickness of soft tissue. It can be employed to improve aesthetic soft-tissue structure around the tooth, implants and intraoral defects.