The Punch Graft Technique: A Simplified Protocol for Three-Dimensional Peri-Implant Soft and/or Hard Tissue Augmentation in a Single Step.

Objective: This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge.

Clinical considerations: Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results.

Conclusions: The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time.

Clinical significance: Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.