BACKGROUND: Peri-implant soft tissue thickness is a critical determinant of esthetic outcomes and long-term implant stability, particularly in the anterior maxilla. METHODS: A 28-year-old systemically healthy male presented with a missing maxillary central incisor and a thin gingival biotype. Following implant placement, a modified split flap-roll technique was performed. The surgical approach involved splitting the flap into epithelial and connective tissue components, followed by mobilization and rolling of the connective tissue into a labial pouch to enhance tissue thickness. RESULTS: Soft tissue thickness increased from less than 2 mm pre-operatively to approximately 4 mm at 3 months, with stable maintenance of approximately 3 mm at 9 months. Improved gingival contour, emergence profile, and uneventful healing were observed throughout the follow-up period. CONCLUSION: The modified split flap-roll technique may serve as an alternative approach for peri-implant soft tissue augmentation. Within the limitations of this case report, favorable clinical outcomes were observed; however, further controlled studies are required to establish its predictability and clinical effectiveness. CLINICAL SIGNIFICANCE: Modification of an existing roll flap technique Eliminates the need for a secondary donor site Allows soft tissue augmentation using a pedicled approach May provide an alternative option in selected cases KEY POINTS: The modified split flap-roll technique increased peri-implant soft tissue thickness from less than 2 mm to approximately 4 mm at 3 months, with stable maintenance at 9 months. The technique utilizes a pedicled connective tissue component, eliminating the need for a secondary donor site and potentially reducing patient morbidity. This approach may provide an alternative soft tissue augmentation option for selected esthetic-zone implant cases. PLAIN LANGUAGE SUMMARY: Dental implants placed in the front part of the upper jaw require healthy and adequate gum tissue to achieve a natural appearance and long-term stability. In some patients, the gum tissue around an implant is thin, which can affect both esthetics and treatment outcomes. This case report describes a modified surgical technique used to increase the thickness of the soft tissue around a dental implant without taking tissue from another area of the mouth. A 28-year-old patient with a missing upper front tooth and thin gum tissue underwent implant placement combined with a split flap-roll procedure. During surgery, tissue from the same surgical site was carefully separated, rolled, and repositioned to create additional volume around the implant. The soft tissue thickness increased from less than 2 mm before treatment to approximately 4 mm after 3 months and remained stable at approximately 3 mm after 9 months. Healing was uneventful, and the final esthetic result showed improved tissue contour and implant appearance. This technique may offer a less invasive alternative to conventional connective tissue graft procedures while avoiding the discomfort associated with a second surgical donor site.
Dsouza et al. (2026) studied this question.