The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 10 ( October, 2021 ) > List of Articles


Use of a Rotational Flap with Soft Tissue Graft and Tunneling Technique for Ovate Pontic Site Development for a Highly Esthetic Outcome: A Case Report

Hafiz A Adawi

Keywords : Esthetic zone, Ovate pontic, Rotational flap, Tissue graft, Tunnel technique

Citation Information : Adawi HA. Use of a Rotational Flap with Soft Tissue Graft and Tunneling Technique for Ovate Pontic Site Development for a Highly Esthetic Outcome: A Case Report. J Contemp Dent Pract 2021; 22 (10):1191-1196.

DOI: 10.5005/jp-journals-10024-3203

License: CC BY-NC 4.0

Published Online: 07-02-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objective: The objective of therapy was to replace the missing teeth with a restoration that closely adhered to the natural teeth and soft tissue contour to provide an esthetic outcome. Case description: A 19-year-old male reported a failed fixed partial denture (FPD) in the maxillary left central incisor. The abutment extended to the maxillary right central incisor and the maxillary left lateral incisor. Radiographic examination revealed that the neighboring maxillary right central incisor abutment was nonrestorable. The treatment plan was the extraction of the maxillary right central incisor with socket preservation, modification of the pontic sites for placement of an ovate pontic for the replacement of the missing maxillary upper central incisors with an FPD with the maxillary lateral incisors serving as the abutment teeth. The pontic sites were corrected with a U-shaped flap extended 5 mm palatal from the mid-crestal line. The incision was avoided at the interdental papilla area. The facial flap was elevated. The facial soft tissue was vertically tunneled. The flap was flipped into the facial tunnel and stabilized with horizontal nylon matrix sutures. The surgical site was stabilized with a provisional FPD with an ovate pontic. The final restoration was a full zirconia facial veneered FPD. Results: Surgical site showed significant healing with a natural emergence profile, and interdental papillae filling the gingival embrasure, showing no evidence of recession. At the 1-year follow-up, the gingival thickness improved and the pontic emergence profile was natural. A very stable result for soft tissue volume and interdental papillae were seen. Conclusion: According to the result obtained with rotational flap, it can be used for small anterior defects with promising results, without the need for bone graft procedures or additional tissue graft. Clinical significance: With proper case selection, the use of a rotational flap with a tunnel technique and an ovate pontic in the anterior esthetic region is an alternative treatment option that can successfully restore masticatory and esthetic function.

  1. Edelhoff D, Spiekermann H, Yildirim M. A review of esthetic pontic design options. Quintessence Int 2002;33(10):736–746. PMID: 12553617.
  2. Abrams L. Augmentation of the deformed residual edentulous ridge for fixed prosthesis. Compend Contin Educ Gen Dent 1980;1(3): 205–213. PMID: 6950834.
  3. Buzayan MM, Mahdey HM, Ning CJ. A new approach for better anterior esthetic using platelet-rich fibrin as sole graft material combined with ovate design dental bridge. J Indian Prosthodont Soc 2020;20(2):219–223. DOI: 10.4103/jips.jips_264_19.
  4. Yang Y, Cui FJ, Liu XQ, et al. Effect of provisional restorations with ovate pontics on preservation of the ridge after tooth extraction: case series. Chin J Dent Res 2019;22(3):181–188. DOI: 10.3290/j.cjdr.a43112.
  5. Van der Weijden F, Dell'Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol 2009;36(12):1048–1058. DOI: 10.1111/j.1600-051X. 2009.01482.x.
  6. Tan WL, Wong TLT, Wong MCM, et al. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res 2012;23(Suppl. 5):1–21. DOI: 10.1111/j.1600-0501.2011.02375.x.
  7. MacBeth N, Trullenque-Eriksson A, Donos N, et al. Hard and soft tissue changes following alveolar ridge preservation: a systematic review. Clin Oral Implants Res 2017;28(8):982–1004. DOI: 10.1111/clr.12911.
  8. Hansson S, Halldin A. Alveolar ridge resorption after tooth extraction: a consequence of a fundamental principle of bone physiology. J Dent Biomech 2012;3:1758736012456543. DOI: 10.1177/1758736012456543.
  9. Chappuis V, Engel O, Reyes M, et al. Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res 2013; 92(12 Suppl.):195S–201S. DOI: 10.1177/0022034513506713.
  10. Babiuc I, Geantă I, Tănase G, et al. Clinical aspects dimensional changes of the alveolar crest following tooth extraction–a cone-beam computed tomography study. Acta Medica Transilvanica 2019;24(19):107–110.
  11. Khouly I, Strauss FJ, Jung RE, et al. Effect of alveolar ridge preservation on clinical attachment level at adjacent teeth: a randomized clinical trial. Clin Implant Dent Relat Res 2021;23(5):716–725. DOI: 10.1111/cid.13040. PMID: 34448354.
  12. Turkyilmaz I, Suarez JC. An alternative method for flapless implant placement and an immediate provisional crown: a case report. J Contemp Dent Pract 2009;10(3):89–95. PMID: 19430631.
  13. Barakat K, Ali A, Abdel Meguid A, et al. Modified roll flap a handy technique to augment the peri-implant soft tissue in the esthetic zone: a randomized controlled clinical trial. Tanta Dent J 2013;10(3):123–128. DOI: 10.1016/j.tdj.2013.11.004.
  14. Giordano F, Langone G, Di Paola D, et al. Roll technique modification: papilla preservation. Implant Dent 2011;20(3):e48–e52. DOI: 10.1097/ID.0b013e3182181771.
  15. Park S-H, Wang H-L. Pouch roll technique for implant soft tissue augmentation: a variation of the modified roll technique. Int J Periodontics Restorative Dent 2012;32(3):e116–e121. PMID: 22408781.
  16. Zuhr O, Fickl S, Wachtel H, et al. Covering of gingival recessions with a modified microsurgical tunnel technique: case report. Int J Periodontics Restorative Dent. 2007;27(5):457–463. PMID: 17990442.
  17. Zabalegui I, Sicilia A, Cambra J, et al. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 1999;19(2):199–206. PMID: 10635186.
  18. Shenoy S, Bhat V, Kottakkunnummal P, et al. Interproximal papilla volumization using vestibular incision subperiosteal tunneling access technique in esthetic rehabilitation. Contemp Clin Dent 2020;11(1):76–78. DOI: 10.4103/ccd.ccd_33_20.
  19. Irinakis T, Aldahlawi S. The dome technique: a new surgical technique to enhance soft-tissue margins and emergence profiles around implants placed in the esthetic zone. Clin Cosmet Investig Dent 2018;10:1–7. DOI: 10.2147/CCIDE.S154152.
  20. Quispe-López N, García-Faria C, Mena-álvarez J, et al. Clinical outcome of a new surgical technique for the treatment of peri-implant dehiscence in the esthetic area. A case report. Appl Sci. 2021;11(11):4781. DOI: 10.3390/app11114781.
  21. Bidra AS, Chapokas AR. Treatment planning challenges in the maxillary anterior region consequent to severe loss of buccal bone. J Esthet Restor Dent 2011;23(6):354–360. DOI: 10.1111/j.1708-8240.2011.00475.x.
  22. Tripodakis AP, Constandtinides A. Tissue response under hyperpressure from Convex pontics. Int J Periodontics Restorative Dent 1990;10(5):408–414. PMID: 2098362.
  23. Burkhardt R, Lang NP. Fundamental principles in periodontal plastic surgery and mucosal augmentation – a narrative review. J Clin Periodontol 2014;41(Suppl. 15):S98–S107. DOI: 10.1111/jcpe.12193.
  24. Salama H, Salama MA, Garber D, et al. The interproximal height of bone: a guidepost to predictable esthetic strategies and soft tissue contours in anterior tooth replacement. Pract Periodont Aesthet Dent 1998;10(9):1131–1141; quiz 1142. PMID: 10093558.
  25. Zitzmann NU, Marinello CP, Berglundh T. The ovate pontic design: a histologic observation in humans. J Prosthet Dent 2002;88(4): 375–380. DOI: 10.1067/mpr.2002.128758.
  26. Bhuskute M. Ovate pontics: phoenixing the gingival contour. J Int Clin Dent Res Organ 2017;9(2):82–85. DOI: 10.4103/jicdro.jicdro_26_17.
  27. Kim SM, Choi YH, Kim YG, et al. Analysis of the esthetic outcome after root coverage procedures using a comprehensive approach. J Esthet Restor Dent 2014;26(2):107–118. DOI: 10.1111/jerd.12085.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.