Healing after microsurgical approach and papilla base flap for implant procedures in the aesthetic zone

Background Appropriate choice of flap design facilitates an optimal blood flow to the surgical site which is fundamental during first phase of healing. The incisions must be placed so as to prevent the development of soft tissue recessions and loss of papilla height. The issue of papilla preservation is of immense importance in periodontal and implant surgery in order to maximize postoperative aesthetics. In this respect the combination of papilla base flap and microsurgical approach could be beneficial. Aim/Hypothesis The main objective of the research was to evaluate the early healing process using the papilla base flap and microsurgical approach for implant procedures in the aesthetic zone. Material and Methods The research included 15 patients having augmentation procedure in the aesthetic zone prior to implant placement. During the second surgery in order to remove membrane fixation pins the extended flap was raised. The papilla base flap consisted of two vertical, releasing incisions connected by the papilla base incisions (PBI) and sulcular incisions. The sulcular incision reached from the releasing incision to the start of the papilla base incision or from one papilla to the next papilla. In the area of papilla base, split thickness flap was created. Further apically full thickness flap was raised. Vertical incisions were carried out bilaterally in the distal third of the canine. The PBI was sutured with two or three polypropylene 7 0 interrupted sutures. In each patient the healing was assessed at two papillae, located between lateral incisor and canine bilaterally according to Early Wound Healing Index (EHI), described by Wachtel et al., 5 days after surgery. Results After 5 days of healing 28 out of 30 papillae could be matched with Wachtel's healing criteria. Only 2 papillae had intrapapillar bleeding, which not corresponded with any of Wachtel's criteria, resulting in hematoma postoperatively impairing the healing process. In these cases, healing after 6 days corresponded with first day of undisturbed, ideal healing. The majority of papillae had no fibrin at the incision line after 5-day healing (EHI 1). Significantly few characterized slightly fibrin at the incision line (EHI 2). Open wound with suppuration or localized pus collection were not recorded. Conclusions and Clinical Implications Microsurgical approach minimizes surgical trauma and enhances surgical results. With papilla base flap there is a potential for improved healing after a very short period of time making postoperative period much more comfortable. Furthermore, maintaining papilla height makes this approach aesthetically-driven. On the other hand, regardless microsurgical approach, unestablished hemostasis and hematoma formation may impair and delay healing process.