{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:01:50Z","timestamp":1786122110813,"version":"build-2736575974"},"reference-count":10,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Peri\u2010implant soft tissue thickness is a critical determinant of esthetic outcomes and long\u2010term implant stability, particularly in the anterior maxilla.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A 28\u2010year\u2010old systemically healthy male presented with a missing maxillary central incisor and a thin gingival biotype. Following implant placement, a modified split flap\u2013roll 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Soft tissue thickness increased from less than 2\u00a0mm pre\u2010operatively to approximately 4\u00a0mm at 3 months, with stable maintenance of approximately 3\u00a0mm at 9 months. Improved gingival contour, emergence profile, and uneventful healing were observed throughout the follow\u2010up period.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The modified split flap\u2013roll technique may serve as an alternative approach for peri\u2010implant 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.<\/jats:p>\n <\/jats:sec>\n \n Clinical Significance<\/jats:title>\n \n \n \n Modification of an existing roll flap technique<\/jats:p>\n <\/jats:list-item>\n \n Eliminates the need for a secondary donor site<\/jats:p>\n <\/jats:list-item>\n \n Allows soft tissue augmentation using a pedicled approach<\/jats:p>\n <\/jats:list-item>\n \n May provide an alternative option in selected cases<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Key Points<\/jats:title>\n \n \n \n The modified split flap\u2013roll technique increased peri\u2010implant soft tissue thickness from less than 2\u00a0mm to approximately 4\u00a0mm at 3 months, with stable maintenance at 9 months.<\/jats:p>\n <\/jats:list-item>\n \n The technique utilizes a pedicled connective tissue component, eliminating the need for a secondary donor site and potentially reducing patient morbidity.<\/jats:p>\n <\/jats:list-item>\n \n This approach may provide an alternative soft tissue augmentation option for selected esthetic\u2010zone implant cases.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n Dental implants placed in the front part of the upper jaw require healthy and adequate gum tissue to achieve a natural appearance and long\u2010term 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\u2010year\u2010old patient with a missing upper front tooth and thin gum tissue underwent implant placement combined with a split flap\u2013roll 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\u00a0mm before treatment to approximately 4\u00a0mm after 3 months and remained stable at approximately 3\u00a0mm 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.70091","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:11:54Z","timestamp":1786090314000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel split flap\u2010roll technique for peri\u2010implant soft tissue augmentation in the esthetic zone: A clinical case report"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0031-7395","authenticated-orcid":false,"given":"Riolla Sanchia","family":"Dsouza","sequence":"first","affiliation":[{"name":"Department of Periodontology A.J. Institute of Dental Sciences Mangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahana","family":"Purushotham","sequence":"additional","affiliation":[{"name":"Department of Periodontology A.J. Institute of Dental Sciences Mangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurav Shankar","family":"Das","sequence":"additional","affiliation":[{"name":"Private Practice Guwahati India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devanarayanan","family":"Nampoothiri","sequence":"additional","affiliation":[{"name":"Department of Periodontology A.J. Institute of Dental Sciences Mangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"43","article-title":"Optimizing esthetics for implant restorations in the anterior maxilla","volume":"19","author":"Buser D","year":"2004","journal-title":"Int J Oral Maxillofac Implants"},{"issue":"12","key":"e_1_2_9_3_1","first-page":"163","article-title":"Soft tissue management at implant sites","volume":"39","author":"Cairo F","year":"2012","journal-title":"J Clin Periodontol"},{"issue":"15","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/clr.13114","article-title":"Effects of soft tissue augmentation procedures on peri\u2010implant health","volume":"29","author":"Thoma DS","year":"2018","journal-title":"Clin Oral Implants Res"},{"issue":"2","key":"e_1_2_9_5_1","first-page":"179","article-title":"Crestal ridge width changes with and without soft tissue augmentation","volume":"31","author":"Grunder U","year":"2011","journal-title":"Int J Periodontics Restorative Dent"},{"issue":"6","key":"e_1_2_9_6_1","first-page":"1","article-title":"Surgical treatment of peri\u2010implant soft tissue defects","volume":"25","author":"Roccuzzo M","year":"2014","journal-title":"Clin Oral Implants Res"},{"issue":"3","key":"e_1_2_9_7_1","first-page":"303","article-title":"Treatment of recession\u2010type defects","volume":"20","author":"Zucchelli G","year":"2000","journal-title":"Int J Periodontics Restorative Dent"},{"issue":"5","key":"e_1_2_9_8_1","first-page":"551","article-title":"Coverage of gingival recessions: microsurgical vs conventional techniques","volume":"21","author":"Burkhardt R","year":"2010","journal-title":"Clin Oral Implants Res"},{"issue":"1","key":"e_1_2_9_9_1","first-page":"45","article-title":"Augmentation of the deformed residual edentulous ridge","volume":"38","author":"Abrams L","year":"1980","journal-title":"J Oral Surg"},{"issue":"7","key":"e_1_2_9_10_1","first-page":"759","article-title":"Root coverage procedures: Cochrane review","volume":"97","author":"Chambrone L","year":"2018","journal-title":"J Dent Res"},{"issue":"3","key":"e_1_2_9_11_1","first-page":"372","article-title":"Measurement of gingival thickness: a clinical study","volume":"47","author":"Cairo F","year":"2020","journal-title":"J Clin Periodontol"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70091","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cap.70091","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:11:56Z","timestamp":1786090316000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.70091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":10,"alternative-id":["10.1002\/cap.70091"],"URL":"https:\/\/doi.org\/10.1002\/cap.70091","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"2026-03-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cap.70091"}}