Pontic site development by modified vascularized interpositional periosteal-connective tissue graft: A case series

Ridge resorption is unavoidable sequelae of tooth extraction, which leads to soft and hard tissue deficiencies and formation of black triangles. Pedicled grafts inherently have advantage of intact vascular supply over free conventional grafts. A vascularized interpositional periosteal-connective tissue (VIP-CT) graft comprises pedicled connective tissue which is rotated anteriorly to the recipient site. It maintains intact vascular supply thus minimizes chances of graft necrosis and the amount of graft shrinkage. The objective of this case series was to achieve stable, esthetically pleasing pontic site using VIP-CT graft in the anterior maxillary region. In the present case series, the pontic site was developed successfully in three patients having ridge deficiency using a modified approach of VIP-CT. After soft-tissue augmentation, the site was altered by placing a cantilevered provisional ovate pontic. Once the emergence profile had achieved by molding the grafted area, permanent restoration using the adjacent implant as an abutment was delivered to patient. Esthetically pleasing anterior restorations, satisfying the patient's esthetic demands were obtained, and results were found stable up to a period of 9–24 months and thus can be concluded that modified VIP-CT is a predictable approach in anterior esthetic areas to enhance the emergence profile.