In this highly difficult surgery Prof. Marc Hürzeler, Munich/Germany, inserts an implant in the anterior region with simultaneously placing a mandibula bone graft and a subepithelial soft tissue graft obtained from the palatinal area. Prof. Hürzeler starts with raising a full flap using a sulcular incision and a micro scalpel blade. After opening up the defect an incision is performed to split the periosteum to increase flap mobility.

An additional incision is made apically of the flap margin to produce a soft tissue graft still connected to the outer flap. The incisal canal is cleaned from tissue and a soft tissue subepithelial graft is taken from the palate in a routine fashion. The soft tissue is then immediately fixed to the outside flap and a linea obliqua transplant taken from the lower right jaw. The bone block is split into two separate pieces and fixed on the labial and palatal residual bone.

The implant is then placed into the shielded area and the gaps filled with a BioOss/autologous bone mixture. A membrane of porcine origin (BioGuide) covers the augmented area and the wound is closed meticulously under the avoidance of any tension.