Buccal periosteal inversion (BUPI) for defect closure and keratinized gingiva width preservation after tooth extraction – technique modification

INTRODUCTION: Several techniques and methods have been proposed to cover alveolar bone after tooth extraction when soft tissue is lacking. Some authors recommend soft tissue flap techniques, and others advocate different types of materials for socket covering. In this article, the authors use a modified buccal inversion technique for adequate coverage of the alveolar ridge to ensure its preservation and to minimize soft tissue shrinkage and loss of keratinized gingiva after tooth extraction. This local mucogingival-periosteal plastic procedure was named by the authors the “Buccal Periosteal Inversion technique” or simply BUPI. MATERIALS AND METHODS: After extraction of a fractured, endodontically compromised lower right first molar, the BUPI technique was performed to cover the alveolus. After reflecting the two-sided full-thickness flap, the periosteum was split in the cranial direction. The inverted periosteum is used to provide tension-free defect closure of the postextractional defect. Detailed technique implementation and patient postoperative healing are presented here in detail. RESULTS: Postoperative evaluation at six weeks was presented with photos showing adequate surgical site healing, no signs of infection or dehiscence, and no crestal shift of the keratinized gingiva. CONCLUSION: The buccal periosteal inversion (BUPI) technique is a modified technique that allows full socket coverage, avoiding a keratinized gingiva shift in the crestal direction using only the periosteum as a cover material. By inverting the buccal ridge periosteum alone from its normal position, the osteoclastic effect on the buccal bony wall will be eliminated, and this procedure abolishes the need for additional alveolar coverage materials.