The Tunneled Coronally Advanced Flap for Vertical Soft Tissue Reconstruction and Papilla Augmentation at Implant Sites (Vertcaf)

Soft tissue augmentation procedures are often needed at anterior dental implants to address esthetic concerns. The surgical techniques for vertical soft tissue augmentation and papilla augmentation at implant sites, their predictability, and outcomes have recently gained popularity among clinicians to meet patients' high esthetic demands. This study describes the application of the tunneled coronally advanced flap for vertical soft tissue reconstruction and papilla augmentation (verTCAF) for the treatment of peri-implant soft tissue dehiscences (PSTDs) characterized by papilla loss. Twelve patients with isolated PSTD in the anterior region were consecutively enrolled and treated with the verTCAF in combination with a connective tissue graft. This approach required a temporary phase prior to the surgery. The verTCAF involved a horizontal and vertical incision, with the opening of one surgical papilla one tooth more distal than the implant site. The anterior region, including the implant site and the interproximal soft tissue were tunneled. A connective tissue graft (CTG) was inserted and stabilized from the lateral opening, where the surgical papilla was raised. After the soft tissue augmentation and a new temporary phase of at least 3-4 months, the cases were finalized with new restorations. Patient- reported outcomes, and clinical and ultrasonographic measures were collected over 1 year to assess the results of the procedure. One year after the intervention, the subjects reported a significant improvement in the esthetics (93.92 visual analogue scale points at the last visit). The overall percentage of black triangle reduction, compared to baseline, was 83.3%. The mean PSTD coverage and complete PSTD coverage were 92.78% and 66.7%, respectively. The average mesial and distal papilla gains were 1.79 mm and 1.46 mm, respectively. A significant increase of the peri-implant soft tissue phenotype parameters was observed, together with a substantial root coverage and papilla gain in natural dentition. The present case series described the application and the promising outcomes of the verTCAF + CTG for PSTDs, exhibiting papilla loss and adjacent teeth with midfacial and interproximal recession.