“M” flap design for promoting implant esthetics: technique and cases series

The objectives of modern implant dentistry are no more to reach only a stable osseointegration, but are now focusing on the quality of the final esthetic result. In the anterior maxillary area, the reconstructions have to be indistinguishable from the natural teeth. Factors such as a thin gingival biotype, a high lip line, triangular shaped teeth, and high patient esthetic demand may affect the final outcome of the treatment in the maxillary anterior region, and many techniques are developed to improve this final esthetic outcome [1,2]. The management of soft tissues during the second-stage of implant surgery (implant uncovering surgery) is an important parameter to improve the final esthetic aspect around the implant-supported restoration. Traditionally, a tissue-punch or a full thickness flap opening prior to abutment connection have been used at this stage. This may lead to bone loss resulting in soft tissue recession, and causes unesthetic implant restorations [3]. Many different flap designs have been advocated to reduce these negative consequences. This includes, but is not limited to: split finger technique [4], by splitting the soft tissue flap in two halves and place them respectively on the mesial and distal sides; roll technique, by moving tissue from palatal side to the buccal area; palatal roll technique, by rotating the palatal tissue after removing the epithelium layer to the buccal side [5] and inlay connective tissue graft [6]. In this article, a simple surgical approach, called “M” flap design, is described and evaluated in a series of 58 cases, to prevent buccal marginal recession and to achieve an esthetic peri-implant soft tissue remodeling and predictable implant-supported gingivaprosthetic integration, particularly during the single tooth rehabilitations.