Oral rehabilitation of the atrophic maxilla using prostheses anchored by zygomatic implants (ZIs) is a well-documented process. To prevent the risk of sinusitis and/or oroantral communication, the placement of ZIs with an externalized path has been proposed. In cases where sealing the implant neck depends exclusively on a hemidesmosome junction, there is a risk of dehiscence in the soft tissue that can lead to esthetic problems, bone resorption, oroantral communication, cellulitis, and even orbital infection. To avoid soft tissue recession in implants placed buccal to the remaining ridge, the simplest procedure is to ensure good buccal coverage of the implant via keratinized tissue. Use of a double pedicle palatal flap is proposed to increase the keratinized tissue buccal to the implant while facilitating the incision closure by primary intention.
