Use of the Pocket-Lining Tissue as a Pedicle Flap to Facilitate Wound Closure After Extraction to Preserve the Alveolar Ridge or Protect an Implant Site

Introduction: Because hard-and soft-tissue remodeling and resorption follows tooth extraction, postextraction ridge deficiencies and abnormalities may require correction before implants can be placed. Equally, where immediate implants are placed, alveolar bone and gingival soft tissue must be protected; thus, primary wound closure of an extraction site is desirable but remains challenging. Guided bone regeneration has made ridge preservation possible and more predictable. However, where barrier membranes remain exposed, infection and graft failure can occur. The technique presented here uses the pocket-lining epithelium that is found at periodontally compromised sites to facilitate primary wound closure. To my knowledge, this is the first report of this technique. Case Presentations: All presented cases had periodontally compromised teeth that were extracted. After extractions, the pocket-lining epithelium was dissected and pedicalized (using the pocket-lining pedicle flap [PLPF] procedure). All vacated sockets were prepared, and dental implants were immediately placed. Guided bone regeneration was used to circumferentially fill the remaining alveolar voids and any bony defects. Thewell-vascularized attached epithelium was used to provide primary wound coverage at the surgical site. Wound healing was uneventful in all the considered cases. Sutures were removed at 4 weeks in all cases. No tissue sloughing occurred, and, when visible, early keratinization was apparent. No soft-tissue dehiscence formation occurred. Conclusions: In this case report, the PLPF provided successful soft-tissue wound closure at extraction sites where implants were immediately placed. The technique appears to visually stabilize the position of the mucogingival junction and may well preserve or enhance the width of keratinized gingival tissue, thus aiding optimal esthetics.