The four-layer graft technique, a hard and soft tissue graft from the tuberosity in one piece.

OBJECTIVE: Successful immediate implant placement in the maxillary anterior zone continues to be a challenge. There is an uncertainty on whether it should be performed on patients with thin gingival phenotype or incomplete buccal plate. This clinical case report describes a novel technique for immediate implant placement with simultaneous hard and soft tissue augmentation.

CLINICAL CONSIDERATIONS: This technique employs a combined epithelialized-subepithelialized connective tissue graft and cortical-cancellous autogenous bone graft for the treatment of incomplete buccal plate at an extraction site. Significant horizontal bone regeneration appears to have been achieved as well as soft tissue augmentation for a central incisor in a single surgical step. Following three and a half years, gingival contours and bone augmentation were stable with a pleasant esthetic result.

CONCLUSIONS: The use of the four-layer tissue graft for immediate implant placement can be suggested to improve hard and soft tissues in a single procedure.

CLINICAL SIGNIFICANCE: The use of the four-layer graft technique has shown to be successful regarding function and esthetic outcomes in anterior immediate implant placement. It reduces surgical interventions and treatment time and minimizes soft tissue recession and bone resorption.