I have seen a lot of different techniques over the years on how to approach the edentulous maxilla with regard to incision design.
I’m often asked about a “palatal incision” design and how I perform this technique.
My answer is always, “I don’t perform a palatal incision technique”.
Shown above is the outline for my incision design for the edentulous maxilla.
Here’s what it looks like clinically.
That’s it.
A crestal incision with a small tuberosity release to allow access to the pterygomaxillary region should pterygoid implants be necessary, and to allow bone reduction to be carried through the posterior aspect of the maxilla.
Here’s why I like this incision and why I specifically don’t perform a “palatal incision”.
1. A crestal incision is much, much easier to reflect.
The angle at which instrumentation can be held relative to the incision line makes subperiosteal dissection much easier.
2. A palatal incision can potentially get quite close to the greater palatine artery.
This can create annoying and unnecessary bleeding.
3. Regardless of incision design, the same amount of keratinized tissue is present around the implant.
I feel there is often the false assumption that a palatal incision creates more keratinized tissue around the implant. However, the amount of keratinized tissue and the implant location remain unchanged. In this scenario, the incision location is irrelevant.
Now, in theory, a palatal incision could allow for the tissue to be repositioned buccally, and the exposed palate allowed to heal secondarily. This could potentially increase the amount of keratinized tissue at the implant site. However, in my opinion this is unnecessary, carries other surgical risks, and is very uncomfortable for the patient.
4. Because I’m normally not planning on (and actually avoiding) performing zygomatic implants, I do not find any release other than at the tuberosity to be necessary.
In my hands, additional releasing incisions actually make the incision harder to reflect, are more prone to tears or a dehiscence, and increase post-op discomfort.
While not incredibly exciting, I find a simple crestal incision to be the most effective for full-arch surgery in the edentulous patient.
Simple. Straightforward. Effective.