Transmucosal Periosteal Releasing Incision: The "Buttonhole Technique." An Innovative Procedure for Soft Tissue Augmentation Surgery.

Introduction: The case presented demonstrates a soft tissue volume augmentation procedure using a transflap ("buttonhole") incision, placed at the mucogingival junction (MGJ), to facilitate the passive advancement of a buccal flap without coronal transposition of the MGJ or reduction of vestibular depth.

Case Presentation: The initial incision was placed crestal and slightly palatal in the area to be augmented. Vertical releasing incisions were placed to facilitate coronal advancement of the flap. Then, a subepithelial connective tissue graft was harvested from the palate and secured in the area to be augmented. A horizontal periosteal releasing incision was placed at the base of the flap to accomplish tension-free coronal advancement of the entire flap and sutured at the incision line. A "through-and-through" incision was drawn at the MGJ. At the level of the "buttonhole" opening, the graft was left exposed. The patient healed uneventfully with increased soft tissue thickness and without coronal displacement of the MGJ or shortening of the vestibular depth.

Conclusions: This case report describes a new variation of the periodontal plastic surgery technique. It offers considerable advantages over previous modalities, using tools that are already in the surgical armamentarium of the periodontist, without increased treatment time or patient morbidity.