Alveolar bone resorption after tooth extraction is an inevitable consequence with an average 20-40% of bone loss in height and width with the greatest loss happening within the first 1-2 years. Socket preseration / ridge augetation become more popular due to the paradigm shift of implant dentistry. Many classifications and techniques have been advocated and applied in this field. However when there's loss of both facial gingiva and buccal plate, the situation turned out to be more challenging. Moreover when extremely thin ridge was encountered, primary wound coverage is crucial but how to achieve this goal without shallowing vestibular depth and jeopardizing the esthetic outcome? Some authors had used free soft tissue graft to achieve this purpose but the slough of the graft in the initial healing phase is not seldom because of the blood supply. Palatal connective tissue flap with blood vessel per se can have better angiogenesis, promote primary wound coverage therefore provide undisturbed space for the bone graft to get a better clinical result.
The lecture will begin with traditional approaches of socket preservation including mineralized bone plug technique, barrier membrane and / or free soft tissue graft in fresh socket then go further to use rotated palatal connective flap to treat the fresh socket and augment the thin ridge to restore the hard and soft tissue defect simultaneously in esthetic zone. This technique can help maintain particulate bone chips from leakage, prevent secondary infection and subsequent complication during critical phase of socket healing and most importantly, can gain hard and soft tissue volume in single visit without shallowing vestibular depth and jeopardizing esthetics. The extra benefits are including but not limited to increase zone of keratinized gingiva and tissue thickness.