Alveolar Ridge Preservation via Intrasocket Granulation Tissue Repositioning: Technical Note on a Novel Flap Design

Abstract

This case report presents a novel, biologically driven approach for alveolar ridge preservation (ARP) using intrasocket granulation tissue repositioning in conjunction with a Bone-Key (BK) incision. A 42-year-old female patient with severe bone loss around tooth #11 underwent ARP using an intrasocket granulation tissue repositioning protocol. The intrasocket granulation tissue was preserved and coronally repositioned to function as a biological sealing layer, whereas the BK incision enabled tension-free flap advancement without compromising the mucogingival junction. No barrier membrane or additional soft tissue grafting was required as a socket-sealing material. Favorable soft tissue healing and ridge volume stability were observed after 2 months, followed by successful implant placement. Radiographic and clinical evaluations at 18 months confirmed stable marginal bone levels and healthy peri-implant soft tissue. This case suggests that the intrasocket granulation tissue repositioning protocol may be a valuable, minimally invasive strategy for ridge preservation, particularly in periodontally compromised sites. Further studies are needed to validate long-term outcomes and define indications for the selective preservation of intrasocket granulation tissue.