LACK OF THE BUCCAL BONE

One of the most important aspects of the mucogingival approach is to elevate the interdental papillae in split thickness. Another great advantage of the mucogingival approach is you can treat adjacent gigngival recessions simultaneously to implant placement. Recession is treated only with the simple CAF, with no graft. 

Tooth is extracted. Severe loss of the buccal plate is observed. Implant is placed. Particulate bone graft (autologous and xenograft) is performed. A pericardium membrane is sutured to the adjacent periosteum covering all the buccal bone graft. We harvest the FGG from the palate, a more extended one than usual, as we have a huge buccal wall defect. We desepithelialize the graft. We suture it against the inner surface of the flap. Before placing the provisional crown the distal papilla is sutured a simple suture, provisional crown is placed and then another simple suture is done mesially. After that a sling suture is done to further displace the entire complex coronally.