The collapsed anterior ridge may have a deep labial concavity that may extend to its crest. It is impossible to adapt a pontic of normal size and shape to such a concavity. The internally placed submucosal connective tissue graft is preferred to the externally placed gingival grafts, color, texture, and contour of the reconstructed ridge will be uniform and harmonious.
A dense connective tissue graft is placed internally between the now-collapsed osseous ridge and the soft mucoperiosteal tissue. A full thickness palatal flap may be reflected and internally thinned to produce a substantial; amount of dense connective tissue. A partial thickness flap is designed lingually to the affected edentulous ridge, beginning in the palate and progressing to the crest of the ridge. Incision are may 1-2 mm from the adjacent teeth. The flap thickness of 1.5-2.0 mm. It then is full thickness at the labial surface of the ridge. The graft is inserted. The area is then sutured.
Alternative is to make a vertical incision in the labial attached gingiva into the mucosa. The area is elevated covering the ridge and the graft is slipped into place.
Post-op changes are complete after 8 weeks.
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