Adjustment of localized alveolar ridge defects by soft tissue transplantation to improve mucogingival esthetics: a proposal for clinical classification and an evaluation of procedures.

Esthetically correct treatment of a localized alveolar ridge defect is a frequent prosthetic challenge. Such defects can be overcome not only by a variety of prosthetic means, but also by several periodontal surgical techniques, notably soft tissue augmentations. Preoperative classification of the localized alveolar ridge defect can be greatly useful in evaluating the prognosis and technical difficulties involved. A semiquantitative classification, dependent on the severity of vertical and horizontal dimensional loss, is proposed to supplement the recognized qualitative classification of a ridge defect. Various methods of soft tissue augmentation are evaluated, based on initial volumetric measurements. The roll flap technique is proposed when the problem is related to ridge quality (single-tooth defect with little horizontal and vertical loss). Larger defects in which a volumetric problem must be solved are corrected through the subepithelial connective tissue technique. Additional mucogingival problems (eg, insufficient gingival width, high frenum, gingival scarring, or tattoo) should not be corrected simultaneously with augmentation procedures. In these cases, the onlay transplant technique is favored.